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COPYRIGHT DEPOSIT. 



A NURSE'S GUIDE 



for 



THE OPERATING ROOM 



h 



IFUcbolas Senn, /llb.H)., iPb.D., OLX.S)., G./HV 

PROFESSOR OF SURGERY, RUSH MEDICAL COL- 
LEGE, IN AFFILIATION WITH THE UNIVERSITY 
OF CHICAGO ; ATTENDING SURGEON TO THE 
PRESBYTERIAN HOSPITAL ; SURGEON-IN-CHIEF, 
ST. JOSEPH'S HOSPITAL ; PROFESSORIAL LEC- 
TURER ON MILITARY SURGERY, UNIVERSITY 
OF CHICAGO ; CHIEF OF THE OPERATING 
STAFF WITH THE ARMY IN THE FIELD DUR- 
ING THE SPANISH-AMERICAN WAR J SURGEON- 
GENERAL OF THE STATE OF ILLINOIS. 






Ipublfsbeo under tbe Direction of tbe Sisters 

of Cbaritg, St. $osepb's ibospttal, 

360 ©arfielo &v. t Cbicago 



W. T. Keener & Co. :: :: Chicago, 111. 

Number Ninety W a b a s h Avenue 






TUr LIBRARY OF 
CONGRESS, 

Two COPtE8 ReCSIVED 

AUG, 23 1902 

OnPVBIOHT ENTPY 

CLASS <^XXc. NO. 
COPY S. 



> 



Copyright, 1902, by the 

Sisters of Charity of St. Joseph's Hospital, 

360 Garfield Avenue, Chicago. 



• • • • • •«» • ••• »tt ■ • 



PREFACE. 

This little book is intended to serve as an aid to the 
trained nurse in her work in the operating room. The 
text is made up largely of abstracts of lectures delivered 
by the Author to the pupils of the Training School of 
St. Joseph's Hospital, Chicago. 

The principal aim of this "Guide" is to instruct the 
nurse in as concise and thorough a manner as possible 
in the details of her responsible duties before, during, 
and after operations. The technique of asepsis is given 
a prominence commensurate with the importance of the 
subject. The most important wound complications are 
mentioned and briefly described, so that the nurse may 
recognize them and give timely warning to the attending 
surgeon. Formulas for the most reliable antiseptic solu- 
tions in common use are given. In giving the directions 
for preparation for the most important major operations, 
a list of instruments is given and ligature, suture, and 
dressing material are described. 

It has been deemed advisable to append illustrations 
of instruments in general use, so as to familiarize the 

nurse with their names and use. 

N. Senn. 

Chicago. April, 1902. 



CONTENTS. 

CHAPTER I. 

PAGK 

Preparation of Operating Room in a Private House 

CHAPTER II. 

Preparation for Major and Minor Operations 12 

Directions for Hand Disinfection 13 

-General Anesthesia 13 

Local Anesthesia 24 

^Spinal Anesthesia 30 

Anesthesia Boom 30 

lntra-Venous Infusion 30 

CHAPTER III. 

Drainage and Drainage Material 34 

CHAPTER IV. 

.Sterilization and Disinfection 35 

Sterilization of Dressings 38 

Sterilization of Instruments, etc : 38 

-Sterilization of Catgut 39 

'Chromicized Catgut 41 

Sterilization of Horse Hair 42 

-'Sterilization of Silk and Silkworm-Gut 42 

CHAPTER V. 

31etric Data 43 

Antiseptic Solutions in Most Common Use 45 

CHAPTER VI. 

Preparation of Dressing Materials 48 

Preparation of Waxed or Paraffin Paper 50 

Havre's Jacket 50 

Venn's Fixation Splint 51 



CHAPTER Vli. 

PAGE 

Preparation of Patient for Laparotomy 52 

Operating Room 53 

Care of Instruments After Operation 55 

Paequelin Cautery 55 

After-Treatment for Laparotomy Patients 57 

Diet 58 

CHAPTER VIII. 

Wound Complications — 

Shock, Hemorrhage, etc 61 

Peritonitis 63 

Septicemia 64 

Sapremia 65 

Pyemia <. 65 

Suturing of Abdominal Incisions 65 

Abdominal Operations — 

Gastroenterostomy. 66 

Gastrostomy 72 

Gastrectomy 72 

Ileocolostomy 72 

Inguinal Colostomy 72 

Herniotomy 73 

Appendectomy 75 

Choleeystenterostoniy 77 

Cholecystotomy 78 

Cholecystostomy 79 

Cholecystectomy 79 

CHAPTER IX. 
( gynecological Operations — 

Uterine Curettage 81 

Perineorrhaphy and Trachelorrhaphy 82 

Colporrhaphy 85 

Vaginal Hysterectomy 85 



Gynecological Operations — Continued — page 

Oophorectomy or Salpingo-Oophorectomy 8G 

Abdominal Hysterectomy or Hysteromyomectomy. . . . 89 

Myomotomy 89 

Cesarean Operation 89 

Obstetric Notes 92 

CHAPTER X. 

Opening of an Abscess 95 

Operation for Hare-Lip 96 

Cheiloplasty 97 

Rhinoplasty 97 

Amputation of Breast 99 

Tracheotomy 100 

Adenectomy 102 

Rectal Fistula 104 

Operation for Hemorrhoids 105 

Phimosis 10G 

Varicocele 106 

Skin Grafting 108 

Excision of Varicose Veins 109 

Nephropexy 110 

Nephrectomy Ill 

Eesection of Bib for Empyema Ill 

Staphylorrhaphy 112 

Amputation of Leg 114 

Perineal Lithotomy 116 

Suprapubic Lithotomy 118 

CHAPTER XI. 

Operations on Bones and Joints — 

Excision of Maxilla 119 

Cranial Osteotomy 121 

Sequestrotomy 123 

Resection of Joints 126 

Arthrectomv 127 



CHAPTER L 

Preparation of Operating Room in a Private House. 

In private homes a room is to be selected that is least 
frequented, and very often the kitchen will recommend 
itself as the best room for this purpose. Carpets, cur- 
tains, pictures and all -unnecessary furniture must be 
removed. Ceiling, doors, floors, walls, windows or 
blinds and all objects in the room must be scrubbed 
thoroughly with hot soda solution, to be followed by 
scrubbing with a solution of corrosive sublimate 
1 :1000 or carbolic acid 5 per cent. 

The air of the room must receive proper attention, 
especially in large cities and in small, badly ventilated 
houses. 

The microbes developed upon the surface of the earth 
find their way in limited number into the lower strata of 
the atmospheric air by currents of wind that carry with 
them visible dust. ^Taegeli showed, a quarter of a cen- 
tury ago, that microbes are transported through the air, 
through the medium of dry dust, never from fluid or- 
ganic media in which they grow. Dry air contains more 
microbes than moist air because more dust is suspended 
in it, which serves as a carrier for the microbes. Rain 
carries with it microbes from the air to the surface 
and purifies the atmosphere. 

Nature's process should be imitated in the operating 
room. The microbes floating in the air should be pre- 
cipitated by moisture in the form of steam or spray; 
bv doing so the air is purified and the microbes become 

2 



10 a nurse's guide 

attached to the moist floor, which should be kept moist 
until the operation is completed. For the cleansing of 
wall paper von Esmareh has recommended rubbing with 
bread, and his advice is based on the results of carefully 
made experiments. 

Whenever possible, the room should be prepared the 
day before the operation, after which the doors and 
windows are closed. In emergency cases this can not 
be done, but the atmosphere can be moistened with 
steam in a very short time during and after the me- 
chanical and chemic cleansing of the room and its con- 
tents. 

The kitchen table can be converted into an operating 
table that will answer every purpose, by placing upon 
it a blanket properly folded and covering the same with 
a clean sheet. 

The kitchen stove does excellent service in sterilizing 
everything that can be sterilized by heat — wash-basins, 
pans, water, instruments, etc. Napkins and towels that 
are to be used during the operation and the sterility of 
which is doubtful should be boiled for five minutes in 
soda solution. Sterile water, hot and cold, and in suffi- 
cient quantity, must be kept in readiness, as well as 
sterile vessels, for use during the operation. 

An active, efficient nurse can prepare any room in 
a few hours so that it will be safe to perform any opera- 
tion, by making liberal use of hot soda solution, hot 
water and potash soap, antiseptic solutions and steam. 

For major, prolonged operations, the temperature 
of the room should be kept at not less than 75 degrees F. 
Warm blankets, bottles filled with hot water, or warm 



FOR THE OPERATING ROOM. 11 

bricks must be kept in readiness to supply the neces- 
sary heat in operations on feeble patients, or in cases 
in which shock is liable to set in as an immediate effect 
of the operation. A hypodermic syringe, strychnin tab- 
lets, capsules of nitrite of amyl, alcoholic stimulants, 
ether and chloroform must be kept within easy reach of 
the anesthetizes 

Brushes used for hand and surface disinfection are 
rendered sterile by exposing them to live steam for 
thirty minutes, or by boiling them in soda solution from 
five to ten minutes. Before hand disinfection is com- 
menced coats are laid aside and the sleeves are rolled 
up securely above the elbows when the operator and his 
assistants are ready for the operating room. Should 
gowns not be on hand, night shirts answer as excellent 
substitutes and in the absence of such, a clean sheet 
may be wrapped around the chest and abdomen and fast- 
ened with safety pins. Towels can be used in the same 
manner for the arms. 

As microbes attach themselves much more readily to 
woolen fabric than linen or calico, the nurses should 
always wear a calico dress and over it an aseptic gown. 
If during the operation the hands of any one connected 
with the operation should become contaminated, they 
should again be thoroughly disinfected. The antiseptic 
solution which the operator may prefer should be placed 
within easy reach to be used when his hands become 
bloody. 



12 a nurse's guidk 



CHAPTER II. 
Preparation for Major and Minor Operations. 

"■ Ample experience has demonstrated that infection by 
contact is to be feared much more than infection by 
microbes suspended in the air. It is generally conceded 
that operation wounds are most frequently infected by 
contact with the hands of the operator or his assistants. 
The risk of infection increases with the number of 
assistants and this statement applies with special 
force to new and inexperienced assistants, as is the 
case with college clinics in our country, in which the 
assistants serve for only three or four months at a 
time. 

Since Eberth discovered numerous bacteria in normal 
perspiration in 1875, it has been found that the surface 
of the body is inhabited by a whole flora of pathogenic 
microbes. They are most numerous upon the hairy 
parts of the skin, in the folds and crevices, in the out- 
lets of the glandular appendages and especially in the 
subungual spaces of the fingers. 

Careful hand disinfection is an essential prerequisite 
to aseptic surgery. The hands of the assistants and 
nurses should be as carefully disinfected and kept so as 
those of the operator. Each hospital has its peculiar 
method of sterilizing hands and arms, also of steriliz- 
ing instruments and disinfection of the field of opera- 
tion or injury. 



FOR THE OPERATING ROOM. 13 

Directions for Hand Disinfection. 

First. — Scrub for fifteen minutes with hot water and potash 
soap hands and arms to elbows. 

Second. — Trim, clean and scrape nails, scrub again in tur- 
pentine, again in hot water and potash soap, rinse with clear 
hot water to remove soap, (soap destroys the antiseptic proper- 
ties of bichlorid) . 

Third.— Alcohol. 

Fourth. — Immerse in bichlorid solution 1:1000 for live min- 
utes, using nail brush and finally wash thoroughly with alcohol. 

The hands thus disinfected are surgically clean, there- 
fore nothing should be touched which is not aseptic. 

If the operator calls for potassium permanganate fur- 
ther preparations are necessary, such as the following: 

Provide four basins: one containing saturated solution of 
potassium permanganate; the second, sterilized water; the 
third, a saturated- solution of oxalic acid, and the fourth a 
1:1000 solution of mercuric bichlorid. 

First, the hands and arms to the elbows are soaked in the 
potassium permanganate solution until the skin becomes 
brown. 

Second, the hands and arms are washed in the sterile water. 

Third, the stain is thoroughly removed from the skin by 
scrubbing with the oxalic acid solution. 

Fourth, the hands are washed in the sublimate solution. 

Fifth, alcohol is freely poured over the hands. 

Adequate preparations for hand disinfection must be 
made in the treatment of all open injuries, for all opera- 
tions surgical, gynecological and obstetrical and all 
obstetrical manipulations. 

General Anesthesia. 

In the absence of a qualified assistant the educated 
nurse is often called upon to administer a general 
anesthetic and should therefore be familiar with the 
method, and quick to discover signs of danger and 



14 a nurse's guide 

prompt in anticipating them by judicious, intelligent 
treatment. 

In emergency work anesthetics must often be given 
without any elaborate preparations, owing to the urgency 
of the case. When time permits, everything should be 
done to make ample preparations for all possible emer- 
gencies. The stomach should invariably be empty. 
Vomiting is likely to be provoked by the anesthetic, and 
the food ejected might enter the air passages, causing 
immediate death from asphyxia or, if this danger is 
passed over, an aspiration pneumonia is a more remote 
complication. If the anesthetic has to be given on a 
full stomach, the patient should be turned on one side, 
with the head in a dependent position during the act 

^^-ftf — rnTFIif fTlllTTTHW 

Sims' sponge-holder. 

of vomiting, so as to favor the ejection of the food from 
the mouth. 

The bowels and bladder should be evacuated, the for- 
mer by cathartics and enema, the latter if need be, by 
aseptic catheterization. 

All unnecessary clothing must be removed, especially 
such as would interfere with the free movements of the 
chest and abdomen. 

The cavity of the mouth must be inspected, and all 
foreign substances, such as artificial teeth, gum, food, 
etc., removed. 

The patient is placed on the operating table, with 
the head on the same level as the body, or slightly 
elevated on a small pillow, or what is still better, a firm 
compress. 



FOB THE OPERATING ROOM. L5 

Upon a small stand or chair at the head of the 
operating table,, and within easy reach of the anes- 
thetizer, are placed all articles needed during narcosis — 
ether, chloroform, tongue-holder, hypodermic syringe 
charged with a solution of 1/30 of a grain of strychnin, 
granules of digitalin, 1/100 of a grain, capsules of 
nitrite of amyl, wash-basin, tongue forceps, a four-ounce 
bottle of whisky or brandy, a two-ounce bottle of vinegar, 
an electric battery, a chloroform mask, an ether cone, 
a sponge holder with small gauze sponges, and a num- 
ber of towels. The anesthetic must be pure — Squibb's 
ether- and chloroform can be relied upon. 

Everything being in readiness for the narcosis, the 
surface of the body not to be exposed during the opera- 
tion should be well protected with woolen blankets so as 
to prevent unnecessary and perhaps dangerous loss of 
body heat during the operation. 

The temperature of the room should be not lower 
than 75 degrees F., and not higher than 85 degrees F.. 
according to the general condition of the patient and 
the nature and probable duration of the operation. 

The skin exposed fo the irritating action of chloroform 
is covered with oil, vaselin, butter, cream, or any other 
fatty substance. 

The anesthetizer takes his place at the head of the 
table, seated on a chair or stool of convenient height. 
The patient's mind must be diverted as much as possible 
from the ordeal before him. With the exception of a 
few words of encouragement, no conversation should be 
carried on between the patient and the anesthetizer after 
the narcosis has commenced. Silence must be strictly 



16 a nurse's guide 

enforced. Anxious relatives and useless bystanders 
should be excluded. 

A few drops of chloroform are poured on the mask, or 
in the absence of such, on a handkerchief folded once or 
twice and held' for a few minutes at least, four inches 
from the face when it is brought gradually nearer, 
but not in contact with the face, until the patient has 
become accustomed to the irritating effects of the vapor. 
The same precaution is necessary in administering ether. 
As soon as the mask has been brought in contact with 
the face, the chloroform is dropped upon it continuously, 
as an abundance of air passes through the loose meshes 



Hypodermatic needle, reinforced. 



Hypodermatic needle, plain. 

of the gauze, thus diluting the vapor of the anesthetic 
and furnishing the necessary amount of oxygen. 

It is during the beginning of the narcosis that the 
patient's mind should be occupied and concentrated 
upon something foreign to the procedure he is under- 
going. This can be accomplished in one of two ways : 
he is asked to count slowly until consciousness is lost, or 
is requested to hold one of the upper extremities in a 
vertical position. The loss of consciousness in the latter 
instance is announced by the dropping of the helpless 
limb. This stage of anesthesia will suffice for short 
operations and when it is intended to operate under par- 
tial anesthesia. Usually complete anesthesia is pre- 
ceded by a stage of excitement of variable duration. It 



FOR THE OPERATING ROOM. K 

is during this stage that the anesthetizer feels keenly 
the weight of his responsibility. The patient shouts, 
prays, swears, sings, cries, laughs or rights, according to 
his temperament, habits, religious belief, occupation or 
social position in life. Tonic and clonic spasms, irregu- 
lar respiration and cyanosis are some of the alarming 
symptoms of this stage. This stage may subside in a 
few minutes or may continue for ten or fifteen minutes, 
or -even for a longer* time. Under the continued admin- 
istration of chloroform by the drop method the excite- 
ment and convulsive movements gradually subside, and 
the narcosis -passes into the stage of tolerance or full 
anesthesia. This is announced by muscular relaxation," 
snoring, puffing of the cheeks, and complete loss of con- 
sciousness and sensibility. The pupil is contracted, the 
eyeballs make asymmetric movements, the pulse becomes 
smaller, softer and more rapid, the respirations become 
more rapid and shallow. This is as far as it is advisable 
and safe to carry the effect of the anesthetic. The 
disappearance of the corneal reflex is an indication that 
the anesthesia has reached the limits of safety. Dilata- 
tion of the pupils is always a signal of great danger and 
a strong and unmistakable reminder that the effect of 
the anesthetic has been carried beyond the limit of safety. 
The administration of the anesthetic must be immedi- 
ately suspended until the pupils contract and the corneal 
reflex returns. 

One of the common first ill effects of the anesthetic 
is the disturbance of the function of respiration. Dur- 
ing the first few inhalations the patient often holds his 
breath and respiration is renewed by asking the patient 



18 a nurse's guide 

to breathe. In other eases the vapor of chloroform pro- 
vokes a distressing cough, but the cough usually sub- 
sides as the anesthesia proceeds. Prolonged expiration 
interrupted by short inspirations is objectionable, be- 
cause it interferes with the free entrance of the vapor 
into the bronchial tubes and consequently retards the 
complete anesthesia. The regularity of respiration in 
such cases is usually restored by talking to the patient 
or by a light blow on the chest. Should these fail, 
raise the foot end of the operating table. Vomiting 
may occur during any of the stages of narcosis, especially 
when the stomach of the patient is not empty. If 




Senn's tongue forceps. 

vomiting is provoked, the head must be turned to one 
side and on a level below that of the body, to pre- 
vent entrance of foreign substances into the air-passages. 
An abundance of mucus and saliva in the pharynx often 
provokes vomiting, in which case the removal of the 
irritating material with a sponge is the best and 
most successful method of preventing or arresting it. 
After each attack of vomiting the cavity of the mouth 
should be cleared of food, mucus and saliva by wiping 
with a sponge, towel or handkerchief before resuming 
the inhalation of the anesthetic. If, in spite of all pre- 
cautions, food should find its way into the air-passages, 
an immediate tracheotomy may become a necessity. A 



FOR THE OPERATING ROOM. 19 

sudden arrest of respiration, which during the beginning 
of the narcosis is usually overcome by attracting the at- 
tention of the patient by talking to him, may become of 
the most serious import during the subsequent stages 
of the narcosis. After a few stertorous respirations and 
stormy, convulsive muscular movements, the rima glot- 
tidis is closed by muscular spasm, the abdominal wall 
makes a few inspiratory contractions, sinks in and re- 
mains board-like. The maxillary bones remain in close 
contact, and the tongue falls backward in such a way 
that the passage to the larynx is narrowed to an extent 
incompatible with a normal supply of air to the res- 
piratory passages. 

The superficial veins of the forehead, temples and face 
become turgid, the face purple and the lips cyanosed. 
The pulse, at first slow, becomes rapid, and lastly almost 
imperceptible. The cause of approaching asphyxia in 
such cases is spasmodic contraction of the muscles of the 
larynx or falling of the tongue backward. Prompt ac- 
tion is necessary to restore the embarrassed circulation. 
The mouth must be opened, and the tongue grasped 
and drawn forward with a tongue-holding forceps 
(Senn's), or if such are not on hand a pair of mouse- 
toothed hemostatic forceps may be used. Lifting of the 
lower jaw forward by making pressure against its angles 
is another valuable expedient in clearing the pharynx. 
On drawing the tongue forward the air-passage is 
cleared and the anesthesia continued with additional 
care. If respiration is not restored upon the removal 
of mechanical impediments, as is so often the case when 
the narcosis is carried beyond safe limits, artificial res- 
piration must be resorted to promptly and continued 



20 



A NURSE'S GUIDE 



until respiration is reestablished, .or all hope of restor-. 
ing life has vanished. While this is being done an 
assistant maintains the patency, of the respiratory tract 
by employing a mouth gag to open the mouth and a 
tongue-holding or hemostatic forceps to draw the organ 
forward. While artificial respiration is being made the 
foot of the table is elevated so as to incline the body 
with the head downward at an angle of 45 degrees. 
The one who makes artificial respiration stands behind 
the head of the patient, grasps both elbows with the arms 




1. Senn's inhaler for ether. 

extended and by traction brings the arms to the side 
of the head so as to expand the chest-wall to its utmost. 
Then the movement is reversed by bringing the arms 
with the forearms flexed to the sides of the chest, which 
is then forcibly compressed for the purpose of forcing 
out from the air-passages as much as possible of the 
contained air (Sylvester's method). These movements 
must be made deliberately and not spasmodically. 
Sylvester's method is the only one of the many methods 
of artificial respiration that have been suggested which 
is entitled to confidence in such cases. The respiratory 



FOR THE OPERATING ROOM. 21 

movements are repeated eighteen to twenty times a min- 
ute, resembling in this respect normal respiration. 
Nothing is gained by increasing the frequency. The 
success of artificial respiration depends on the thorough- 
ness with which every movement is made. If respira- 
tion is not restored promptly there is no reason for 
despair, as success has followed efforts continued for half 
an hour or more. The efforts should be maintained for 
at least half an hour unless unmistakable evidences of 
death make their appearance and warrant suspension of 
further attempts at resuscitation. 

During the time attempts are being made to restore 
respiration other means of counteracting the toxic 
effects of chloroform are employed. The most potent 
physiologic antidote for chloroform is strychnin. 
Horatio C. Wood advises heroic doses. In adults the 
first dose should be not less than one-sixth of a grain 
by subcutaneous injection. This may be safely repeated 
in ten or fifteen minutes if the nervous centers do not 
respond to the first dose. 

Inhalations of nitrite of amvl stimulate the heart's 
action and are well calculated to relieve the stagnant 
capillary circulation. Slapping the chest with a towel 
wrung out of cold or hot water and the rubbing of the 
extremities are valuable agents in accomplishing the 
same object. Faradization of the phrenic nerve is an- 
other valuable resource in restoring respiration tem- 
porarily suspended by the toxic action of chloroform on 
the respiratory center. The two electrodes are applied 
one on each side of the neck over the clavicle at the 
outer border of the sterno-cleido-mastoid muscle. Al- 
though the immediate cause of death from chloroform 



22 . a nurse's guide 

is generally its toxic action on the center of respiration, 
alarming and fatal complications may set in, which are 
directly referable to its depressing effect on the heart 
muscle. Such accidents occur usually when least ex- 
pected, and with a suddenness that is appalling. In a 
moment the color of the face is changed to a deadly 
pallor; the pupils dilate and do not respond to light; 
the corneal reflex disappears; the lower jaw drops ca- 
daver-like; the pulse is either very small, rapid and 
flickering, or imperceptible; the heart sounds are in- 




2. Senu's inhaler for chloroform. 

audible; bleeding of the wound ceases; respiration, al- 
though shallow and irregular, may continue for a short 
time until it ceases after a few spasmodic efforts, similar 
to those observed in a dying person. Such a terrible 
scene is fortunately rare and when it does occur it is 
most frequently met in anemic patients and in those the 
subjects of organic disease of the heart. Nevertheless, 
it may occur in persons in perfect health, more especially 
if they are apprehensive, nervous and excited before the 
operation. Prompt action is urgently indicated in all 
cases of anesthesia in which heart depression follows 



FOR THE OPERATING ROOM. 23 

as one of the toxic effects of the anesthetic. Inversion 
of the body is the first measure to be employed in 
such cases — to accomplish this in the shortest possible 
space of time, the foot-end of the operating table is 
elevated to an angle of at least forty-five degrees. This 
position relieves the existing cerebral anemia and by 
doing so the heart center and the heart likewise are 
stimulated by the increased supply of blood. The pa- 
tient is at the same time placed most favorably for arti- 
ficial respiration which becomes necessary if there is, as 
is so often the case, at the same time an inhibition of 
the respiratory function. Heart stimulants by hypo- 
dermic injection are always indicated. Of these digi- 
talis or digitalin, strychnin, alcohol and coffee will 
prove most effectual. Tincture of digitalis or digitalin, 
the former in half-dram closes, the latter in doses of 
from 1/100 to 1/50 of a grain every ten to fifteen 
minutes until reaction takes place, will prove most suc- 
cessful. In very grave cases it should be combined 
with strychnin in decided doses. Camphorated oil ad- 
ministered in the same way, in closes of two or three 
^yringefuls. is a very powerful cardiac stimulant en- 
titled to confidence in such cases. Alcohol in the form 
of whisky, brandy, cognac or rum, can be given at short 
intervals by subcutaneous injections or by the rectum. 
The application of dry heat to the extremities and trunk 
should never be neglected. Friction with hot cloths is a 
potent vascular stimulant and will be useful in aiding 
the other remedies in restoring the general circulation. 
The physiologic effect of ether is closely allied to 
that of chloroform, differing, however, from the latter 
in that the intracranial blood supply is rather increased 



24 a nurse's guide 

than diminished under full anesthesia and it is there- 
fore less likely to cause depression of the heart's action. 
The ultimate toxic effects on the brain and spinal cord 
are almost identical with those of chloroform, and hence 
its use demands the same preliminary preparations and 
precautions during its administration. The cone must- 
be held at first at least six inches from the face and as the 
patient becomes accustomed to the penetrating odor 
of the vapor it is brought slowly nearer, until it rests 
evenly on the surface and close enough to prevent the 
entrance of air underneath it. 

It must not be forgotten that ether is a highly in- 
flammable substance and on this account special care 
must be exercised in its use in operations where the aid 
of lamp light is necessary and in the use of the Pacquelin 
cautery near the ether cone. Accidents during ether 
narcosis are met by the same treatment as has been de- 
scribed under the head of Chloroform Anesthesia. 

The subject of General Anesthesia may be summarized 
briefly as follows: Proper preparation of patient; 
adequate supply of the different antidotes and means 
of restoring suspended respiration ; pure anesthetics and 
slow continuous inhalation ; dilution of the vapor with a 
liberal supply of air ; unremitting vigilance and prompt, 
efficient and persistent treatment when unfavorable or 
alarming symptoms make it necessary to interrupt the 
anesthesia. 

Local Anesthesia. 

Local anesthesia is the ideal condition under which 
to operate, as it relieves the operator from all anxiety 
regarding the dangers incident to the administration of 
a general anesthetic. Ice applied for a sufficient length 



FOB THE OPERATING ROOM. 



35 



of time produces a decided local anesthetic effect which 
includes the whale thickness of the skin. The degree 
of cold is increased, and its anesthetic properties inten- 
sified, by mixing common salt with crushed ice. The 
ice and salt should be well mixed and applied in a 
gauze bag or in a towel. As soon as the skin is whitened 
by the cold an incision can be made through it with little 
or no pain. This is one of the simplest and at the same 
time most efficient procedures for preventing pain in 
excising small tumors of the skin and in incising super- 
ficial abscesses. 




Henrotin's gag. 

Sulphuric ether is also used in the form of a spray. 
An ordinary hand spray answers an excellent purpose. 
Under the action of the spray the skin is partly frozen 
in a very few seconds and a small incision can be made 
without any pain. 

The anesthetic area in this method of local anesthesia 
is small, as the spray must be concentrated for the pur- 
pose of producing the anesthetic degree of cold. Dur- 
ing the local reaction from the freezing process, the 

patient experiences a prickling pain in the part, which 
3 



26 



A NURSE S GUIDE 



can be relieved to some degree by immersion in warm 
water. , 

More effective than ether are the chlorids of methyl 
and ethyl. The first is applied to the skin in a com- 
press saturated with it and held against the part to be 
frozen. The area of anesthetization is regulated in this 
instance by the size of the compress, possessing in this 
respect a decided advantage over the ether and chlorid 
of ethyl spray. Chlorid of ethyl is so volatile that it 




DAVIDSON RUBBER CO. 



Esmai-ch's elastic constrictor. 

boils at the temperature of the body. For local anes- 
thesia it is put up in glass tubes with a neck supplied 
with a metallic attachment from which the spray escapes 
under body-temperature on removing the metallic cork. 
In using the spray the tube is held for a few moments 
in the hollow of the hand, when the cork is removed and 
the spray begins. The indications for the use of the 
chlorid ethyl spray are the same as for the ether spray. 
Cocain is one of the latest and most useful of local 
anesthetics. Applied to mucous surfaces in solution of 



FOR THE OPERATING BOOM. 2"i 

from 2 to 10 per cent., it produces a complete super- 
ficial anesthesia in from three to five minutes. It is 
used largely in ophthalmic surgery and operations upon 
mucous membranes. The surface must be carefully 
cleansed before the solution is applied. It has no 
effect upon intact skin. To procure anesthesia of the 
skin it is necessary to inject the solution into it and 
not under it. If a certain area of skin is to be anes- 
thetized, the injections are to be made with a hypodermic 
syringe with a fine point under the strictest aseptic pre- 
cautions, using in preference a fresh solution, the asep- 
ticity of which can be depended upon. The needle- 




Esmarch's tongue forceps. 

point is entered obliquely and enough fluid is injected 
to raise a circular portion of the skin, which then re- 
sembles a blister. Tension is an important element in 
the anesthetization of the skin, as well as the local ane- 
mia produced by it. These punctures are made in a 
straight line if the incision is to be made in this direc- 
tion, circular or oval, according to the nature of the 
operation, and sufficiently close together so that the 
different centers of local anesthesia touch each other. 
After the first puncture is made, the needle is always 
inserted through the skin already anesthetized. 

Cocain is not an indifferent drug. Many cases of 
severe intoxication and a few deaths from its use have 
been reported. The toxic effects of cocain are mani- 



28 



A NURSE S GUIDE 



festecl by pallor, dizziness, fainting, headache and de- 
lirium, symptoms which demand immediate suspension 
of its further use. To relieve this condition nitrite of 
amyl must be administered by inhalation, to be followed 
if the patient does not rally promptly, by subcutaneous 
injection of strychnin and alcohol by mouth or rectum. 
For subcutaneous use the cocain solution has been 
displaced almost entirely by Schleich's infiltration 
method. This method consists in the use of cocain and 




Esmarch's mask and dropping bottle. 

morphin in small doses, in normal salt solution suffi- 
cient in amount to produce the necessary degree of ten- 
sion and local anemia. Schleich recommends the fol- 
lowing solutions, which are known as Nos. 1, 2 and 3„ 
according to their strength: 

SCHLEICH' S SOLUTION. 

No. 1, Strong. 
Cocain muriate, 0.2 gm. (3 gr.). 
Morphin muriate, 0.025 gm. (2/5 gr.). 
Sodium clilorid, 0.2 gm. (3 gr.). 
Sterilized water, 100 c.c. (3 2/5 fl. oz. ). 



FOE Till: OPERATING ROOM. g!) 

Xo. 2, Normal. 

Cocain muriate, 0.1 gin. (T'L. gr.). 
Morphin muriate, 0.025 gm. (2 5 gr.). 
Sodium chlorid, 0.2 gm. (3 gr.). 
Sterilized water, 100 c.c. (3 2 5 ll. oz.). 

Xo. 3, Weak. 
Cocain muriate, 0.01 gm. (1/6 gr.). 
Morphin muriate, 0.025 gm. (2/5 gr. ). 
Sodium chlorid, 0.2 gm. (3 gr.). 
Sterilized water, 100 c.c. (3 2/5 ii. oz. ). 

3 



Glover's needles. 

To each of the solutions two drops of a 5 per cent, 
solution of carbolic acid may be added if they are in- 
tended for stock solutions, to preserve them in a more 
nearly perfect antiseptic state. 

Of the Xo. 1 solution as much as 6.5 fluid drams 
may be injected during one operation; of the No. 2 as 
much as 3.4 fluid-ounces, and of the No. 3 even a pint 




Mouse-toothed tissue forceps. 

has been used with safety. The No. 2 solution is the one 
generally used, the strong and weak solutions being ap- 
plicable only in exceptional cases. In infants and chil- 
dren a general anesthetic is preferable to local infiltra- 
tion by Schleiclr's method. 

Xo. 1, the strong solution, is seldom used. Beta-eu- 
cain is now frequently used as a substitute for cocain, 
as it is less toxic and produces the same anesthetic 
effects. 



30 a nurse's guidk 

Spinal Anesthesia* 

Local anesthesia on a large scale is now occasionally 
practiced by injecting cocain or beta-eucain solution 
into the spinal canal. The injection is made with a 
hypodermic needle — the parts below the seat of injection 
are thereby rendered anesthetic. 

Anesthesia Room* 

Pin a towel around the head of the patient, remove 
the night gown, roll undershirt up over the chest, put 
on surgical drawers, remove false teeth, and replace 
the antiseptic compress with a sterile towel saturated 
with warm solution of bichlorid 1 :1000, and over this 
place a sterilized towel. When the patient is anesthe- 
tized put on a laparotomy gown, catheterize, wrap 
lower limbs in a blanket and cover with a sterile sheet. 
The patient is then ready to be transferred to the operat- 
ing room. 

The anesthesia room should always be supplied with 
pure ether and chloroform, appliances for restoring 
suspended respiration and the antidotes for the anes- 
thetics. The temperature of the room should be com- 
fortable and all noise and excitement carefully avoided. 

Intra- Venous Injection* 

This procedure has almost entirely taken the place of 
transfusion of living blood from one person to another 
or from an animal to a person. This operation is re- 
sorted to in cases of grave shock or dangerous hemor- 
rhage. 

Aseptic measures must be strictly observed in this 
as in all other operations. 



FOB THE OPERATING KOO.M 

Articles needed: 

One elastic constrictor. 

One tenotome or small scalpel. 

Two tissue forceps. 

Two tenaculum hooks. 



»1 




Mouse-tooth tissue forceps. 

Two blunt hooks. 
Two pairs scissors. 
Three artery forceps. 
One aneurysm needle. 
One pair small retractors. 




Hypodermatic case. 

One small canula (a glass tube drawn out into ;i 
fine point), to which is attached a small rubber tube 
sixteen inches long. At the other end of the tubing 
attach a glass cylinder or funnel (a glass syringe with- 



32 



A NURSE'S GUIDE 



out a piston will answer). Into the receptacle is poured 
the physiologic solution of salt at a temperature of 
100 degrees F. Prepare one quart of this solution in 
distilled water. 

In emergency cases the ordinary fountain syringe is 
sometimes used. 



Tenotome. 

Ligatur.es : 

Aneurysm needle armed with medium-sized catgut 
ten inches long to ligate vein. 
Sutures: 

Two glover's needles for silkworm gut. 

One glover's needle for horse hair. 




Kocher's hemostatic forceps. 

Dressing : 

Iodoform and boric acid powder, 1 :5. 

Iodoform gauze. 

Sterilized cotton. 

Three sterilized towels. 

Sterilized gauze sponges. 

Boiler bandage and safety pins. 



FOR THE OPERATING ROOM. 33 

There is one great danger attending this operation — 
the injection of air into the vein causing air-embolism. 
To avoid this see that the solution is running freely be- 
fore the surgeon inserts the canula. 



34 A XURSE'*S GUIDE 

CHAPTER III. 
Drainage and Drainage Material. 

Drainage is used to prevent the accumulation of 
serum, pus or wound excretions. This is effected by 
means of tubular and capillary drains. 

Tubular Drains. — Tubular drains are made of per- 
forated rubber and glass tubing. A perforated glass 
tube loosely packed with gauze constitutes a combined 
tubular and capillary drain. 

Capillary Drainage. — Capillary drainage is made with 
strips of iodoform gauze, hygroscopic gauze, or a skein 
of catgut or horse hair. 

Mikulicz Drain. — The Mikulicz drain consists of a 
square piece of iodoform gauze of requisite size placed 
in a cavity, and tilled with narrow strips of gauze until 
the requisite degree of compression is secured; this 
drain is used where there is parenchymatous oozing — 
it serves as a tampon to arrest bleeding and also acts as 
a capillary drain. 



FOB THE OPERATING ROOM. o-> 

CHAPTER IV. 

Sterilization and Disinfection. 

Both of these terms are employed to indicate the 
use of measures intended to remove, destro) T or render 
harmless microscopic vegetable parasites, germs or mi- 
crobes, which are the cause of all infective processes 
and infective diseases. By sterilization is meant the 
absolute absence of pathogenic microbes from instru- 
ments, solutions or dressing materials — a condition at- 
tainable with any degree of certainty only by exposing 
these articles to a degree of heat sufficient to destroy 
bacterial life. Dry heat, steam and boiling are the 
processes which effect sterilization if the articles are ex- 
posed to the germ-destroying effect of heat for a suffi- 
cient length of time.. Steam, over-steam and boiling are 
now the most common and widely accepted means of 
effecting sterilization. 

Boiling of instruments, drainage tubes, or any ma- 
terial for dressing, for fifteen minutes, in a 1 per cent. 
solution of carbonate of soda can be relied upon in the 
sterilization of any and all articles thus treated. The 
addition of carbonate of soda is important, as it pre- 
vents rusting of the instruments and dissolves and re- 
moves fat. 

The term disinfection applies more particularly to 
the means and measures resorted to in rendering in- 
fected wounds aseptic and in freeing the hands and 
field of operation of all harmful bacteria as nearly as 



36 a nurse's guide 

can be done by mechanical and chemical processes. 
No method so far devised has proved successful in ren- 
dering the skin absolutely sterile, hence some surgeons 
are in the habit of wearing sterilized rubber gloves dur- 
ing operations for the purpose of reducing the danger of 
infection. 

The use of the razor, potash soap and warm water is 
a preliminary mechanical means to prepare the way 
for a thorough disinfection by chemical agents, which 
are known to destroy or inhibit the growth of microbes, 
of which the most important are carbolic acid, corrosive 
sublimate, lysol. creosol and alcohol. 

Physical sterilization is sterilization by heat, Dry 
heat, heated dry air, ranges in sterilizing power above 
the chemical means, but below hot water and steam, as 
dry heat has very little penetrating power. 

Bacteria which do not contain spores are destroyed 
in dry heat after an hour and a half at a tempera- 
ture of 212 degrees F., while three hours' exposure at a 
temperature of 284 degrees F. is required to kill spores. 
Moist heat is the best germicide. 

The thermal death-point of surgical bacteria, which 
practically means pyogenic cocci which are not spore- 
bearing, and the bacillus of tuberculosis and its spores, 
is correspondingly low when they are exposed to moist 
heat. The pyogenic cocci are all killed inside of ten 
minutes at a temperature of about 150 degrees F.. while 
the tubercle bacilli and their spores are destroyed at a 
temperature of 212 degrees F. in five minutes. 

Boiling for five minutes at a temperature of 212 de- 
grees F. seems, therefore, to hold good for all practical 
purposes. Moist heat as steam is another excellent 



FOB THE OPERATING ROOM. 31 

germicide, as ii nets like hot water of the same tempera- 
ture and it <an be used where boiling is not practicable. 
The germicidal properties of steam depend upon its 
moisture, on its temperature and on its expulsion of 
air contained in the articles to be sterilized. Steam 
of a higher temperature than the boiling point is ob- 
tained either by conducting the steam evolved through 
heated pipes (called super-heated steam), or by evolv- 
ing steam under pressure (high steam). All known 
pathogenic bacteria and their spores are destroyed in 
low steam at a temperature of 212 degrees F. maintained 
for five minutes. Low steam at a temperature of 212 
degrees F. is therefore surgically perfect and easily 
generated. 

Concerning the moisture, it is a well-established fact 
that the condensation of steam in the articles to be ster- 
ilized is a most important factor in the success of ster- 
ilization. The exact cause of this is not fully under- 
stood. Wet steam will sterilize but dry steam will not. 
"Wet or saturated steam is steam as delivered from a 
mass of water and holding water in suspension mechan- 
ically or as vapor. This is the sterilizing steam. Dry 
or super-heated steam (steam gas) holds little or no 
water in suspension. This is the non-sterilizing steam. 
It corresponds in effectiveness with dry heated air. 

Spores. — The spores of bacteria represent the seeds of 
flowering plants. Each spore develops into a bacterium 
and thus one crop after another is produced. Most of 
the bacilli multiply by spores. The spores are much 
more refractory to destructive agents than the microbes 
into which they develop. This is particularly true of the 
bacillus of tuberculosis and tetanus. 



38 a nurse's guide 

Sterilization of Dressings* 

Wrap in a separate towel cotton, gauze, sponges, 
laparotomy compresses, sheets, bandages, doctors' gowns, 
nurses 7 gowns, and sterilize thirty minutes with moist 
heat and thirty minutes with dry heat. Note the time 
after the water has reached the boiling point. 

The usual laparotomy dressing consists of a strip of 
absorbent cotton, eleven by fifteen inches, covered with 
sterilized gauze (hygroscopic) ; on this is put one yard 
of sterile gauze and a half yard of iodoform gauze 
loosely applied. This dressing is retained in place by 
two adhesive plaster strips, length twenty inches, width 
two inches. For the majority of wounds in abdominal 
sections a simple abdominal bandage held in place by 
perineal straps, is required; but for hernia operations, 
or in any- case where the incision is low in the abdomen, 
a gauze roller bandage is preferred. If the surgeon 
calls for collodion dressing, give three-inch strip of iodo- 
form gauze and collodion in a small glass with camel's 
hair brush; also a thin layer of cotton, which is placed 
over the gauze. When the wound is sealed with the 
collodion apply the usual laparotomy dressing without 
the iodoform gauze. 

Instruments, etc. — Place in the sterilizer (common 
wash boiler will answer) instrument trays, basins, 
pitchers, etc., and boil for fifteen minutes in a 1 per cent, 
solution of carbonate of soda. Disinfect the tables with 
carbolic acid 3 per cent., or with alcohol, cover the floor 
of trays with sterilized gauze, reserving one tray and 
an aseptic brush for soiled instruments, cover the bottles 
with sterile gauze and handle corks, covers, etc., with an 
aseptic gauze sponge. 



FOR THE OPERATING ROOM.. ')'•' 

A celebrated surgeon remarks : "Before an operation 
it is comparatively easy to render everything surgically 
clean, but it is extremely difficult to keep them so during 
the operation." 

Place in sterilizer, instruments, pins and needles 
and boil for fifteen minutes in 1 per cent, solution of 
soda carbonate. Knives and scissors are boiled for 
five minutes and placed in a glass dish with alcohol 
(heat dulls cutting edges). All instruments are in- 
jured by corrosive sublimate. When instruments are 
sufficiently sterilized, the tables, trays and hands having 
been previously prepared, remove cover from sterilizer 
with an aseptic towel and arrange instruments in the 
trays in such order that each one may be readily found 
when called for by the surgeon. Before the operation 
the needles are threaded and kept in alcohol. Ar- 
range on the table a bottle of alcohol, bottle of collo- 
dion, aseptic glass, camel's hair brush, iodoform pow- 
der, iodoform and boric acid powder 1 :5, salicylic acid 
and boric acid 1 'A, small glass jar with sterilized safety- 
pins, glass jar with three- and eight-inch strips of 
iodoform gauze and a glass dish for knives and scissors. 

Unless intimately acquainted with the surgeon's 
methods it is well to have him inspect before opera- 
tion, the instruments and sutures which you have pre- 
pared. Instruments which have become contaminated 
during an operation must not be used again until they 
have been sterilized by boiling. 

Sterilization of Catgut. 

(Catgut: made from submucosa of the intestine of sheep.) 
The raw material contains -fat and is infected with 



40 a nurse's GUIDE " 

First — Eoll the catgut without any other prepara- 
tion in single layers on glass tubes, roll tightly, evenly,, 
leaving a space between each turn, fasten firmly at each 
end so that it will not loosen during the sterilization. 

Second — Soak in sulphuric ether for three days, then 
place in glass jars for two days to dry. 

Third — Immerse in solution of formalin 4 per cent. 
for forty-eight hours. 

Fourth — Place the tubes in a basin under a faucet 
from which the hot and cold water run together (have 
the temperature of the water about 98 or 99 degrees F.) 
for twelve hours. Pack in a jar, dry, for several days. 

Fifth — Boil the catgut on the tubes in clear water 
for fifteen minutes — the water should reach the boiling 
point (212 degrees F.) before the catgut is put in. 

Sixth — Place in alcohol for twenty-four hours. 

Seventh — Take catgut off the tubes and roll in small 
bundles or on glass spools. 

Nos. 1. 2 and 3, cut in lengths of twenty inches, 
several strands in each coil. One strand answers for a 
suture and when cut in two makes two single ligatures. 

Nos. 4 and 5, cut in lengths of twenty-five inches,, 
several strands put together, and tie a loose knot on one 
end and roll in bundles. 

Preserve in the following solution : 

Alcohol, 1 pint; glycerin, 1 dram, 24 drops; iodoform, l 1 /^ 
ounces, 40 grains. 

The glass jar or bottle in which the catgut is pre- 
served should be well shaken from time to time, espe- 
cially before taking the catgut out for use, so that some 
of the particles of iodoform may remain in the catgut. 

For fine and medium catgut use 2 per cent, formalin, 



FOB THE OPERATING ROOM. 41 

omit the ether and boil from seven to ten minutes. The 
formalin hardens the catgut and is also a powerful 
germicide. Catgut when boiled or immersed in a watery 
solution becomes soft and unsafe for tying, therefore 
absolute alcohol should be used. The glycerin dilutes 
the alcohol sufficiently and acts as a lubricant without 
tending to soften the catgut. 

Catgut thus prepared is not only aseptic, but mildly 
antiseptic, and the iodoform does not irritate the tissues 
like carbolic acid and corrosive sublimate. 

Note. — The deformalized catgut is left in the jar for several 
days to give a chance to the remaining spores to develop into 
bacteria, which are more surely destroyed by boiling. 

Von Bergmann's Method of Catgut Sterilization* 

After removing the fat by immersion in sulphuric- 
ether for from twenty-four to forty-eight hours, accord- 
ing to the size of the catgut, place the strands in a 1 
per cent, solution of corrosive sublimate, dissolved in 
eighty parts of alcohol and twenty parts of water, the 
vessel to be shaken frequently. 

Chromicized Catgut* 

Chromicized catgut is more durable than catgut 
prepared in any other manner. Eoll the catgut 
without any other preparation in single layers on 
glass tubes.* tightly, evenly, leaving a space be- 
tween each turn, and fasten firmly at each end 
so that it will not loosen during the sterilization. Soak 
in sulphuric ether three days, then immerse in a 4 per 
cent, solution of formalin for forty-eight hours. Place 

"""G.ass tubes six inches long, one inch in diameter, four per- 
forations at each end, half inch from the end. 
4 



42 a nurse's guide 



the tubes in a basin under running water for twelve 

hours. After this process boil the catgut on the tubes 

fifteen minutes, then soak in alcohol twenty-four hours. 

Take the catgut off the tubes, roll in small bundles and 

immerse in the following solution for one hour : 

Chromic acid solution. 

Chromic acid 38% grains. 

Carbolic acid 27 dr. 

Sterilized water 57 ounces. 

When very strong, heavy catgut is required, soak 
in the formalin, 4 per cent., five or six days, boil only 
ten minutes and immerse in chromic acid solution two 
or three hours. 

When preparing fine and medium catgut use' 2 per 
cent, formalin and do not immerse in the sulphuric 
ether. 

Sterilization of Horsehair. 

Wash thoroughly with hot water and potash soap. 
Place the threads in line and fasten at one end. Wrap 
in a piece of gauze (for the purpose of keeping it under 
the water), and boil for ten minutes in % P er 
cent, solution of soda carbonate; change this solution 
and boil again ten minutes in clear water. 

Preserve in a solution of hydrarg. bichlorid and al- 
cohol 1:1000. 

Sterilization of Silk and Silkworm Gut. 

Boil for thirty minutes in a 1 per cent, solution of 
soda carbonate. Preserve in a solution of hydrarg. bi- 
chlorid and alcohol 1 :1000. 



FOB THE OPERATING ROOM. 43 



CHAPTER V. 
Metric Data. 

Nurses are not always familiar with quantities ex- 
pressed in the metric system, hence are inserted simple 
data, which may be of use. 

The meter, a Greek word meaning measure, is the 
unit of length; it approaches very nearly to our com- 
mon yard. This measure or meter is divided into frac- 
tional lengths of tenths, hundredths and thousandths. 

The tenth of a meter is called the decimeter, the prefix 
deci meaning 1/10. The hundredth of a meter is called 
the centimeter, the prefix centi meaning 1/100. The 
thousandth of a meter is called the millimeter, the pre- 
fix milli meaning 1/1000. 

If one-tenth of a meter is one decimeter, then ten 
decimeters must make one meter. 

One one-hundredth of a meter being one centimeter, 
then one hundred centimeters must make one meter. 

One one-thousandth of a meter being one millimeter, 
then one thousand millimeters must make one meter. 
The terms of expressing the multiples of the meter are : 
Ten meters make one decameter; the prefix deca mean- 
ing 10-fold. 

One hundred meters make one hectometer ; the prefix 
hecto meaning 100-fold. One thousand meters make 
one kilometer, the prefix kilo meaning 1000-fold. 

Ten thousand meters make one myriameter ; the prefix 
myria meaning 10,000-fold. 



41 a nurse's guide 

It is seen that the measurements both of the multiples 
and subdivisions increase and decrease by tens. From 
the measure of lengths all others are obtained, those of 
capacity, weight, and area. The unit of fluid measure 
is derived in this way : A cube is constructed 1/10 of a 
meter, or one decimeter, in all its dimensions of length., 
breadth, and depth. This vessel is the unit of capacity, 
and is called the liter. This unit is too large — being 
the equivalent to about one quart — for use in measur- 
ing medicines, and just as we find no use for gallons, 
quarts, and pints, but use fluid ounces, fluid drams and 
minims, so with the metric system we throw aside the 
liter and use one of its subdivisions. In place of a 
cube one decimeter in all its dimensions, we construct 
one that is one centimeter or 1/100 of a meter in length, 
breadth, and depth, and we call this vessel a cubic centi- 
meter, using the abbreviated sign C.C. The unit oi 
weight is called a gram, and is expressed by gm. The 
weight which will exactly balance a cubic centimeter ves- 
sel filled with water gives us this unit called the gram. 
We have then for our units the meter, or measure of 
length; the cubic centimeter, or measure of fluid quan- 
tities; the gram, or measure of weight. 

The French or Metric System of Weights and 
Measures. 

A Short Table of Equivalents Easy to Remember, 

500 c.e. in place of one pint. 
500 gm. in place of one pound avoirdupois. 
30 c.c. in place of one fluid ounce. 
30 gm. in place of one ounce weight. 
4 c.c. in place of one fluid dram. 
4 gm. in place of one dram weight. 
1 c.c. in place of m. 15. 
1 gm. in place of grs. 15. 



FOR THE OPERATING ROOM. 45 

Reversing Them. 

One pint in place of 500 c.c. 

One pound in place of 500 gm. 

One fluid ounce in place of 30 c.c. 

One ounce weight in place of 30 gm. 

One fluid dram in place of 4 c.c. 

One dram weight in place of 4 gm. 

Fifteen minims in place of 1 c.c. 

Fifteen grains in place of 1 gm. 

One teaspoonful or fluid dram in place of 4 c.c. 

One dessertspoonful or 2 drams in place of 8 c.c. 

One tablespoonful or 4 drams in place of 16 c.c. 

One wineglassful or 2 fl. ounces in place of 60 c.c. 

One cupful or 4 fl. ounces in place of 120 c.c. 

One tumblerful or 8 fl. ounces in place of 240 c.c. 

The equivalents for fractional parts of a grain are 

quite easy to obtain mentally if the equivalent of one 

grain is memorized. This equivalent is 65 milligrams. 

and is written thus : 0.065 gm., or 65/1000 of a gram. 

Sixty-five milligrams being one grain, then the half 

of a grain would be half of sixty-five milligrams, which 

in round numbers would be 0.033 gm. (33 milligrams). 

1/4 grain would be 1/4 of 0.065 or 0.016 gm. 

1/8 grain would be 1/8 of 0.065 or 0.008 gm. 

1/30 grain would be 1/30 of 0.065 or 0.002 gm. 

1/60 grain would be 1/60 of 0.065 or 0.001 gm. 

1/3 grain would be 1/3 of 0.065 or 0.020 gm. 

1/30 grain would be 1/30 of 0.065 or 0.002 gm. 

1/10 grain would be 1/10 of 0.065 or 0.006 gm. 

Antiseptic Solutions in Most Common Use* 

Solution of hydrarg. bichlorid, 1:1000. 

Hydrarg. bichlorid cor 61% grs. 

Citric acid or sodium chlorid 61% grs. 

Water 1 gal. 

1 :1000 is the standard solution for the operating room 
and from it are made the weaker ones which are 
used for irrigation. 



46 a nurse's guide 

To make 1 :2000, take one pint of 1 :1000 and a pint 
of boiled water. 

To make 1:3000, take one pint of 1:1000 and two 
pints of boiled water. 

To make 1 :4000, take one pint of 1 :1000 and three 
pints of boiled water. 

Continne the same scale for weaker solutions. 

Carbolic acid solution. 

Carbolic acid is used in the strength of 1 to 5 per cent. 
One per cent, solution take 95 per cent. carb. ac. .8% dr. 

Sterilized water 1 gal. 

Five per cent, solution take 95 per cent, carb ac. . .6y± oz. 
Sterilized water 1 gal. 

Boric acid solution. 

Boric acid 4 per cent., 5 oz. 1 dr., boiled water one gallon. 

Salicylic acid solution 3:1000. 

Salicylic acid 184 grs. 

Soda bicarb 120 grs. 

Mix well and gradually add boiled water to make one gallon. 

Thiersch's solution. 

Salicylic acid 123 grs. 

Boric acid 1 y 2 ozs. 

Boiled water 1 gal. 



Chlorid of zinc solution, 10 per cent. 

Chlorid of zinc 

Distilled or soft water boiled 8 ozs. 



Chlorid of zinc 384 grs. 



Bromin solution. 

Bromin 1 dram. 

Potassium bromid 2 drams. 

Water 1 pint. 

(For external use only.) 

Physiologic solution, 6/10 of 1 per cent. 

Sodium chlorid 368 grains. 

Water, sterilized 1 gal. 

Lysol and ereasol in 1 or 2 per cent, solution are often 
used as substitutes for carbolic acid. These substances 



FOR THE OPERATING ROOM. 47 

are efficient antiseptics and are less irritating and toxic 

than carbolic acid. 

To avoid mistakes the sublimate solution should be 

stained a light blue with anilin dye, the carbolic acid 

solution a light purple, and the physiologic solution a 

light yellow with tincture of curcuma. 

Iodoform emulsion, 10 per cent. 

Finely powdered iodoform, one ounce, or one part by 
weight. 

Glycerin, nine ounces, or nine parts by weight. 

Boil glycerin, bottle and cork for fifteen minutes; 
when cool add the iodoform powder and shake well. 

One of the most important precautions in handling 
antiseptic solutions is to read carefully the labels. 



48 a nurse's guide 



CHAPTER VI. 

Preparation of Dressing Material* 

Iodoform Gauze. — Cut the gauze in lengths of five 
yards and sterilize for thirty minutes before medication. 
Handle with surgically clean hands. Sheets, towels and 
everything coming in contact with the gauze must be 
aseptic. 

Solution No. 1. 

Glycerin y 2 gallon. 

Water % gallon. 

Mix and boil for fifteen minutes. When cold pour into a 
large stone jar which has been rendered aseptic. 

Solution A T o. 2. 

Iodoform 3 ounces. 

Alcohol 1 pint. 

(Mix). 

Note. — The iodoform is not perfectly soluble in the quantity 
of alcohol; however, it answers the purpose. 

Add No. 2 to No. 1, and while stirring briskly im- 
merse thirty ounces or thirty yards of gauze (on an 
average a yard of gauze weighs an ounce) ; continue 
the motion until the gauze is thoroughly and evenly im- 
pregnated with the iodoform, otherwise the latter will 
sink to the bottom and the gauze will not retain the en- 
tire quantity. Then pass the gauze through an aseptic- 
wringer, that is, one that has been scrubbed with potash 
soap, rinsed with sterile water and carbolic acid 5 per 
cent. Fold the gauze, roll it tightly, wrap in waxed 
paper and seal. Preserve in a stone jar. 



FOB THE OPERATING ROOM. 4A) 

If more than thirty (30) yards of gauze is to be pre- 
pared, add to the remaining solution if necessary, one 
ounce of glycerin and three ounces of iodoform dissolved 
in one pint of alcohol, as this is absorbed by each thirty 
yards of gauze. Then proceed as described above. 

To improve the color of the iodoform solution, add 
about one dram of tincture of curcuma for every thirty 
yards of gauze. 

Formula for tincture of curcuma: 

Powdered curcuma 4 ounces. 

Proof spirit 1 pint. 

Let stand till clear. Pour off clear liquid. Continue to add 
proof spirit till all color is extracted. 

Corrosive sublimate gauze. 

Corrosive sublimate 10 grains. 

Glycerin % pint. 

Distilled water 32 ounces 

Sodium chloric! % ounce. 

Citric acid 1 ounce. 

Mix well. 

This solution will moisten sixty yards. Cut in 

lengths of five yards each and soak for some time to 

thoroughly saturate the gauze, fold and wrap in waxed 

paper, making air-tight and place in a tin box. 

Carbolized Gauze. 

Carbolic acid 3 ounces. 

Glycerin 24 ounces. 

Distilled water 32 ounces. 

This solution will moisten sixty yards of gauze. Cut 

in five yard lengths, fold, roll, wrap in waxed paper 

and keep in air-tight tin boxes. 

Borated cotton. 

Immerse the absorbent cotton in a saturated solution of 
boric acid. Wring out and dry slowly. Do not open the roll 
of cotton until after it has been saturated thoroughly in the 
boric acid. 



50 a nurse's guide 

Preparation of Waxed or Paraffin Paper. 

Melt the wax or paraffin (the latter will answer and 
is much cheaper), and while pouring it on, iron evenly 
with a hot flatiron. 

A more rapid and better method is to pass the paper 
immediately after its immersion in the melted material 
through the mangle in the laundry, being careful not to 
have the rollers too hot, as in this event the paper 
would be scorched. 

For sealing the rolls of gauze, wax is preferable to 
paraffin. 

Note. — Waxed or paraffin paper also serves an excellent pur- 
pose as a protective in the application of stupes or poultices, 
and is much less expensive than oiled silk or gutta-percha 
tissue. 

Sayre's Jacket. 

A plaster-of-paris jacket to support the spine for the 
correction of 

Scoliosis : lateral curvature of spine. 

Lordosis : anterior curvature of spine. 

Kyphosis : posterior curvature of spine. 

The patient should have a bath and be attired in a 
smooth-fitting undershirt and stockings. 

He is suspended in Sayre's apparatus, which is an iron 
tripod intended for this purpose. 

If the patient be a small child have him stand on a 
stool. 

Prepare cotton to pad the headgear, two muslin pads 
six inches long, two inches wide and one inch thick; 
these pads are placed on each side of the spine, a pad of 
cotton to serve as a dinner-pad; tie a strip of bandage 



FOR THE OPERATING ROOM. 51 

around the cotton with which to draw it out when the 
cast is formed. One dozen plaster-of-paris bandages. 

Senn's Fixation Splint for Intracapsular Fracture 
of Femur. 

(Intracapsular: within the capsule of a joint.) 

The patient receives a bath and wears a pair of knit 
drawers. Having been placed on Sayre's suspension ap- 
paratus, the splint is applied on the injured side with 
plaster-of-paris bandages from toes to axilla and on 
the other side from knee to axilla. For the purpose pro- 
vide : 

One roll of cotton. 

Six three-inch and five seven-inch roller bandages. 

Two dozen plaster-of-paris bandages and a stool or box 
upon which the patient may stand. 

These patients require a fracture bed, which should 
consist of iron and measure 6% feet in length, 2% f ee * 
in height and 3 feet in width, and be provided with an 
adjustment to tighten the springs. It should be fur- 
nished with a hard hair mattress weighing about twenty- 
five pounds. 



52 a nurse's guide 



CHAPTER VIL 

Preparation of Patient for Laparotomy* 

Except in emergency cases the preparatory treatment 
should be commenced three days before operation, dur- 
ing which time the patient is strictly confined to light 
though nutritious diet, and receives each day a warm 
bath, laxative, and in operations on uterus or vagina, 
vaginal douche. To patients who have stricture of 
the esophagus, pylorus or intestine, no cathartic is given, 
but with the doctor's permission give a high enema. 
For pyloric or intestinal obstruction, wash out the stom- 
ach (gastric lavage). 

On the evening before the operation and previous to 
shaving the abdomen, denude the pubes with scissors 
and apply a potash soap poultice. After an hour remove 
the poultice and shave the entire abdomen, pubes and 
genitalia, scrub with hot water and potash soap; wrap 
a little cotton on the end of a match or probe to cleanse 
the umbilicus. Wash off with sterile water and scrub 
again, using turpentine and soap; rinse with warm 
water and dry with gauze ; rub ether well into the skin, 
sponge with alcohol, then use warm bichlorid solution 
1 :1000 and cover the field of operation with a three- 
yard compress of sterile gauze, saturated with warm so- 
lution of bichlorid, strength 1 :3000, oiled linen or waxed 
paper, pad of cotton and enclose all in a snug abdominal 
bandage, held in place by perineal straps. 



FOR THE OPERATING ROOM. 53 

For abdominal and vaginal hysterectomy, also for 
operations on cervix, the uterine canal should be disin- 
fected in the following manner : Wrap gauze around 
the index finger, or an artery forceps, and mop out with 
hot water and soap ; then use clear water, give a douche 
of bichlorid 1 :4000 and pack cervix with a strip of 
iodoform gauze. One hour before the operation remove 
the gauze and give corrosive sublimate douche and mop 
vagina thoroughly with alcohol before repacking. 

Each of the following articles should be in readiness 
before commencing to prepare the patient : One pitcher 
of hot water, bottle of warm bichlorid, two basins, small 
bottle of turpentine, ether and alcohol, brush, potash 
soap, razor, probe tipped with cotton, several pieces of 
gauze, oiled linen, gutta-percha tissue or waxed paper, 
cotton pad, abdominal binder, perineal straps, eight 
safety pins and a pair of scissors. 

The patient receives a very light supper and no break- 
fast. One-half ounce of brandy diluted with water may 
be given four hours previous to the operation. 

A specimen of urine should be placed in a sterile 
bottle for examination. 

Five hours before the operation give a high enema of 
castile soap suds followed by a small one of clear water 
to rinse the bowel. 

Before leaving the room the patient is attired in clean 
clothing, including a pair of stockings; the hair plaited 
tightly in two braids. 

Operating; Room. 

The assistant nurse scrubs the field of operation, using 
hot water and potash soap, then washes off with warm 



54 a nurse's guide 

water, scrubs again with ether or turpentine and soap, 
rinses with clear water, sponges with alcohol and uses 
warm solution of bichlorid 1 :1000, covering the abdomen 
with moist antiseptic towel. After patient is placed on 
the operating table, the head nurse applies laparotomy 
sheet and surrounds field of operation with dry steril- 
ized towels. The operator and his assistants, having 
gone through the thorough disinfection of hands, are 
dressed in white sterilized operating gowns and caps or 
with sterile towel pinned around each one's head. The 
head nurse takes charge of the instruments, ligatures 
and sutures. Immediately before the incision is made, 
she pours alcohol on the hands of operator and assistants. 
She is then prepared to anticipate every want of the 
surgeon, beginning with the scalpel, following with for- 
ceps, scissors, etc., as may be required. Having pro- 
vided a separate tray, she brushes the soiled, instruments 
when necessary and takes each needle from the surgeon 
when he is through with it, for if left lying about, serious 
injury to the patient may result. 

The senior nurse takes charge of the sponges and 
laparotomy compresses. She stands conveniently near 
the assistant who is to do the sponging; if asked to do 
the sponging, she does not wipe but merely compresses 
the bleeding parts, allowing the sponge to absorb what 
it will. After the peritoneum is opened, she hands 
the small sponges on a hemostatic forceps ; this is called 
"steel sponge." The laparotomy compresses will then 
be needed. These, before being handed to the surgeon, 
are wrung out of a hot solution of sodium chlorid 
6/10 per cent, (about one dram of salt to one pint of 
water, called physiologic solution). A hemostatic for- 



FOE THE OPERATING ROOM. f>5 

ceps is attached to each compress. The nurse being ac- 
countable for compresses, keeps a record of them and 
before the incision is closed she counts them again to 
make sure that none is left in the abdomen. 

Upon the junior nurse devolves the care of the doc- 
tors' hands and brows. If anything not aseptic has 
been touched by them she hands bichlorid solution, or 
when only blood is to be removed a basin of warm phy- 
siologic solution of salt suffices. 

For a laparotomy the temperature of the operating 
room should be 75 to 80 degrees F., consequently the 
doctors will perspire profusely ; a few drops of this mois- 
ture striking the open wound might cause sepsis ; there- 
fore, to avoid this danger, the nurse must wipe the doc- 
tors' brows. This nurse must be on the alert to notice 
and supply every want, if so directed by the head nurse. 

One of the highest qualifications of a good nurse in 
the operating room is to anticipate the wants of the 
surgeon. 

Care of Instruments After Operation. 

Collect, count and unlock instruments. Cleanse in 
the following manner: Brush with warm water to re- 
move blood, brush with hot water and potash soap, place 
under hot-water faucet and allow the boiling water to 
run on them. Dry immediately with gauze. When re- 
moving rust from instruments, use sapolio very carefully, 
as otherwise the surface of the instruments will in time 
become injured. 

Pacquelin or Thermo-Cautery* 

Pacquelin or thermo-cautery is a form of actual cau- 
tery in which the heat is produced by blowing benzine 



5G 



A NURSE'S GUIDE 



vapor into a heated platinum point (platinum, silver 
white, almost infusible metal). 

When the cautery is to be used the nurse should test 
it before the operation. Never blow the benzine vapor 
into the platinum point until the point is well heated 
in the flame of an alcohol lamp or gas stove ; then com- 
mence by pressing the bulb slowly. Place the bottle 
containing the benzine in a basin of hot water ; this will 




Thermocautery. 

hasten the heating of the point. See that the rubber 
tube through which the benzine vapor is conveyed is not 
twisted or doubled up. Next, keep the platinum point 
in the name until it is well heated. Sometimes the cause 
of the cautery not working is in the benzine, which 
should be renewed frequently. 

When the doctor is through with the cautery burn it 
out immediately. This is done by placing the point in 
ihe flame until the platinum is again well heated, then 



FOR THE OPERATING ROOM. 57 

quickly remove the rubber tube attached to the handle 
and press the tube between the thumb and index finger 
to prevent evaporation. Great care must be taken 
in handling the cautery, as the benzine is highly ex- 
plosive. 

Hand the cautery to the surgeon with moist sterilized 
gauze wrapped around the handle. 

After-Treatment for Laparotomy Patients* 

In the treatment after laparotomy the nurse must be 
on the lookout for and give timely information of the 
onset of serious complications, the most important of 
which are shock, secondary hemorrhage and peritonitis. 

The patient is carefully conveyed, without raising 
head or chest to a bed, which has been previously pre- 
pared with a rubber and a draw sheet, well supplied 
with hot-water bags or bottles, for armpits and 
lower extremities. Cover the hot-water bags or bottles 
that they may not burn the insensible patient (much 
harm has been done by not observing this precaution and 
a number of suits for damages have been based on care- 
lessness or negligence in this respect). The patient is 
placed in the dorsal (recumbent) position, with the 
limbs flexed to relax the abdominal muscles. A pillow 
is placed under the knees to support them. This posi- 
tion is retained for forty-eight hours, during which time 
the patient is constantly watched. At the termination 
of this period the patient may be carefully turned on 
either side. Pulse and temperature should be taken 
immediately after operation — temperature should be- 
taken by rectum. (Never take aged persons' tempera- 
ture in the axilla.) 
5 



58 a nurse's guide 

Hypodermatic syringe, brandy, strychnin, nitrogly- 
cerin, digitalis, flannel bandages, and blocks to elevate 
the foot of bed should be kept in readiness. 

The distressing thirst is relieved by sips of hot water 
given at short intervals or by fragments of cracked ice. 
No food by the month should be given during the first 
forty-eight hours. In cases of persistent vomiting stim- 
ulants and food are administered per rectum. 
- All articles and medicines necessary in the after-treat- 
ment should be arranged on a little table in the patient's 
room before the return of the patient from the operat- 
ing room. 

Diet* 

After a laparotomy the patient receives nothing in 
the form of nourishment by mouth for at least thirty- 
six hours. The mouth should be frequently sponged 
out and the lips moistened. A small piece of ice 
wrapped in a sponge and rubbed over the lips is very 
soothing to the patient. If he complains of extreme 
thirst very hot water may be given in one-half ounce 
doses, but as seldom as possible. Small pieces of ice 
in the form of ice pills are sometimes allowed. Hot 
water, being a stimulant, is preferred to ice, which is a 
sedative. Another objection to ice is the germs which 
it contains. However, the following is a point in favor 
of ice — nervous vomiting may be controlled by rubbing 
the patient's lips with ice. The best method in such 
cases is to give nothing by mouth, but to relieve thirst 
by rectal or subcutaneous injections of physiologic solu- 
tion of salt, thus securing for the stomach complete 
rest. When giving food or medicine by mouth assist 



FOR THE OPERATING ROOM. 



59 



the patient as much as possible. If the patient is ex- 
tremely weak, nutritive enemata are prescribed. 

In the absence of all bad symptoms, towards the end 
of the second day patient may have a little peptonized 
milk, beef essence, chicken broth or kumyss, varying the 
amount from one-half ounce to a half glass, according 
to the condition of the patient, increasing the quantity 




Elastic catheter. 



gradually. The majority of laparotomy cases require a 
cathartic as soon as they recover from the effect of the 
operation. A teaspoonful of sulphate of magnesia dis- 
solved in hot water given every hour until the bowels 
move freely is the best course to pursue in relieving the 







**p 



Glass catheters. 

patient and in guarding against peritonitis. If the pa- 
tient is vomiting and unable to take a cathartic give a 
high enema of magnesia sulphate ounces 2, glycerin 
ounces 4, and water ounces 8 ; use the rectal tube. 

A hot-water bag applied over the bladder often pre- 
vents retention of urine ; if obliged to catheterize, which 
should not be done under six hours after operation, use 



60 a nurse's guide 

a soft rubber catheter (Nelaton) ; see that it has been 
boiled and afterwards kept aseptic. Carefully disinfect 
your hands and the urethral orifice so that no path- 
ogenic microbes are carried with the instrument into 
the bladder, which might cause cystitis. In the case 
of women the glass catheter (Kelly's) is the instrument 
to be preferred ; should the catheter slip into the vagina, 
it should be disinfected by boiling before re-inserting. 
In inserting the instrument always avoid using force 
and observe the strictest aseptic precautions. 



FOR THE OPERATING ROOM. Gl 



CHAPTER VIIL 
Wound Complications— Shock, Hemorrhage, Etc. 

Surgical shock. — This may result either from injury 
or operation. It is characterized by its sudden onset 
and great prostration. 

Symptoms : Almost imperceptible pulse, subnormal 
temperature, feeble and often irregular and sighing res- 
piration, countenance pale and body cold to the touch. 

Treatment: Elevate the foot of bed (by force of 
gravity the blood will flow toward the head) ; surround 
the patient with hot-water bags; give brandy hypoder- 
matically and give strychnin, grain 1/30; repeat in 
three hours if necessary; atropin. grain 1/60, for the 
respiration. Ether administered subcutaneously is also 
a prompt heart stimulant. Caffein or strong black coffee 
is a simple and excellent heart stimulant. Saline in- 
fusion subcutaneously, intravenous or by rectum, is fre- 
quently called for in such cases. With the doctor's per- 
mission have the patient inhale amyl nitrite; nitro- 
glycerin may also be given. Camphorated oil given hy- 
podermatically is a favorite stimulant and should always 
be kept in readiness. 

Internal and secondary hemorrhages often stimulate 
shock very closely, but the symptoms appear gradually 
and correspond in severity with the amount of blood 
lost. 

The most prominent symptoms are: dilated pupils, 
extreme pallor of face, subnormal temperature, wiry 



02 a nurse's guide 

rapid pulse, frequent yawning, cold perspiration, ex- 
treme thirst followed in grave cases by convulsions and 
death. 

Notify the doctor at once. Keep the patient quiet, 
give no stimulants, as they would increase the heart's 
action and thereby aggravate the hemorrhage; apply ex- 
ternal heat. While waiting for the doctor, prepare 
physiologic solution of sodium chlorid, four-ounce rec- 
tal injecting syringe, flannel bandages and the following 
emergency table : 

A flask of brandy. 

Solution of strychnin. 

Tablets of digitalin. 

Hypodermatic syringe. 

Tincture of digitalis. 

Tablets of nitroglycerin. 

Amyl nitrite pearls and a towel to apply them. 

Electro-magnetic battery with a glass of water to 
moisten the electrodes. 

Mouth-gag, so that no time will be lost in preparing 
these life-restoring remedies. After the doctor has ar- 
rested the bleeding, he may inject the normal salt solu- 
tion into the vein (intravenous infusion, see page 
thirty-one ) . A four- to sixteen-ounce solution of the 
same given by rectum is also beneficial. 

If the patient is sinking rapidly, the nurse is allowed 
to make auto-transfusion by elevating the foot of the 
bed and by elastic compression or constriction, but only 
one limb at a time, so that the patient may be kept alive 
until the doctor arrives. The elastic constriction should 
never be continued for more than two hours at a time. 



FOR THE OPERATING ROOM. G<5 

Peritonitis. 

(Peritonitis: Inflammation of the peritoneum, serous mem- 
brane lining abdomen.) 

This is the next danger to be apprehended after 
laparotomy. 

Symptoms : High temperature, quick wiry pulse, 
vomiting, distended abdomen, and severe, continuous 
pains. 

In the most serious forms of septic peritonitis the 
temperature is sometimes subnormal, pain absent as 
well as tympanites, but the pulse and dry tongue indi- 
cate the existence of progressive sepsis. 

A four-ounce enema of glycerin and water equal parts 
will sometimes relieve tympanitic pains imimediately. 
However, the patient should have free defecation at once. 
Give a saline cathartic; the action of saline cathartics 
can be hastened by the administration of a turpentine 
enema (one-half ounce of turpentine, two ounces of cas- 
tor oil to one quart of soap suds). A brisk saline ca- 
thartic promotes absorption of fluids and bacteria from 
the peritoneal cavity, and by so doing removes the essen- 
tial cause of peritonitis. 

Patients with tympanites should have the abdomen 
examined frequently for the first forty-eight hours. 

One exception to the rule of giving a cathartic is 
when the operation is performed on the intestines and 
in the formation of an artificial anus ; in the latter case 
the bowel is kept at rest until it is incised, which is 
usually done on the second or third day after the opera- 
tion. 

In case of beginning peritonitis and intestinal ob- 
struction the nurse is, if requested, to administer a 
High Rectal Enema. 



64 a nurse's guide 

Prepare one gallon of soap suds, add four ounces of 
sulphate of magnesia, four ounces of castor oil and two 
ounces of turpentine; mix well and raise the irrigator 
containing the fluid eight feet above the level of the 
patient. Place the patient on his right side, elevate 
the foot of the bed three feet; insert the rectal tube 
and in the case of adults administer the whole gallon, 
which will take from one-half to one hour; assist the 
patient to retain the solution as long as possible, by 
compressing the anus with a towel. Lower the foot of 
the bed, turn the patient on his back and place the bed- 
pan under him, then elevate the head of the bed at least 
two feet. 

Septicemia, 

(A general infective process from absorption of septic 
products, usually the result of infection with pus microbes. ) 

Septicemia usually begins with a chill or sense 
of chilliness followed by a gradual rise of temperature. 
The pulse is rapid, feeble and compressible. The ton- 
gue is usually furred and dry. Headache is often com- 
plained of in the beginning of the attack. The urine is 
scanty and heavily loaded with urates. Delirium, rest- 
lessness, insomnia, are symptoms which denote approach- 
ing danger. 

The debilitating effect of toxins on the heart are met 
by the timely and judicious administration of stimu- 
lants. 

Note. — When administering strong stimulants note the pulse 
frequently. 

Treatment: Digitalis, strophanthus, strychnin and 
atropia in small doses are excellent cardiac tonics and 
stimulants, and are indicated in cases where the pulse 



FOR THE OPERATING ROOM. 65 

is very rapid and soft, denoting a feeble peripheral cir- 
culation from a weakened heart. 

Alcoholic stimulants are to be given in doses suffi- 
ciently large to improve the character of the pulse and 
at sufficiently short intervals to maintain this effect 
without interruption. Brandy or whisky in doses of an 
ounce every two hours diluted with water are most to 
be relied upon, but champagne and Greek sherry are 
excellent substitutes. Concentrated liquid food like 
beef tea, milk or eggnog must be given at regular inter- 
vals to assist the action of the stimulants in sustaining 
the heart's action. 

Sapremia. 

Sapremia is caused by the absorption of ptomains 
from putrefying substances in the body, as, for instance, 
a decomposing blood clot. The symptoms pointing to 
intoxication usually yield promptly to the removal of 
the putrefying material and thorough disinfection. 

Pyemia. 

Pyemia is one of the gravest of all wound complica- 
tions. It develops in connection with a suppurating 
focus and is indicated and characterized by severe chills 
at irregular intervals and an irregular temperature. If 
the patient lives long enough suppuration in one or 
different parts of the body is to be expected. The gen- 
eral treatment of sapremia and pyemia is the same 
as of septicemia. 

Suturing of Abdominal Incisions. 

Surgeons differ in their methods in closing an abdom- 
inal incision. Some use silver wire, others silk, silk- 
worm gut or catgut as suturing material. Some unite 



66 a nurse's guide 

the incision with one row of sutures which are made to 
include the entire thickness of the .margin of the wound. 
Keith's long needles armed with silkworm gut, silk or 
silver wire are best adapted for this kind of suturing. 
Most of the surgeons now employ four rows of sutures. 
The first row includes the peritoneum, the second the 
fascia of the recti muscles, the third the skin and under- 
lying fat tissues and the fourth the skin only. 

If catgut is used the peritoneum is sutured with very 
fine silk or No. 1 catgut, for which a fine round curved 
needle is used. The second row consists of catgut sutures 
No. 3, which are inserted with a larger round curved 




Keith's abdominal needles. 

needle. The third row, of silkworm gut sutures, re- 
quires a curved needle with cutting edges. The horse- 
hair sutures constitute the fourth row ; for these sutures 
a small glover's needle answers the best purpose. The 
subcuticular suture (Halsted) is used by some in unit- 
ing the skin. These are fine catgut sutures from which 
the epidermic layer of the skin is excluded. 

Abdominal Operations. 

Gastroenterostomy, 

(Gastroenterostomy : Formation of a new opening between 
stomach and intestine.) 

This operation is required for patients who are suffer- 
ing from carcinoma or cicatricial stricture of pyloric 



FOR THE OPERAT1XG ROOM. 



G7 



orifice of the stomach. Kequired for the operation are 
the following instruments and suturing material : 

Two scalpels. 

Two tissue forceps. 




Kocher's director. 

Two artery forceps (3 inches) 
Eighteen hemostatic forceps. 
One needle holder. 




Sharp-pointed curved scissors. 

One Kocher's director. 

One probe. 

One blunt hook. 




Kelly pad. 

One tenaculum. 

One pair small blunt retractors. 

One pair large blunt retractors. 

One pair scissors, straight. 

One pair scissors, curved, blunt point. 



68 



A NURSE S GUIDE 



One pair scissors, curved, sharp point. 
Murphy button (oval). 

One pair Sennas perforated, decalcified bone plates 
(large size). 




Spencer Wells' hemostatic forceps. 

Ligatures : 

Catgut No. 1 and No. 2, ten inches long. 
Braided silk No. 5. ten inches long. 



Blunt four-pronged retractor. 

Two cambric needles with spring eye for Lembert 

sutures. 
Four cambric needles for braided silk No. 5. 




Scissors curved on fiat. 



Two small round curved needles for catgut No. 1 

for peritoneal sutures. 
Three surgeon's needles for catgut No. 3, to suture 

the fascia. 



FOB THE OPERATING ROOM. 



69 




E. J. Senn's automatic tissue forceps. 




Halsted's straight artery forceps. 




Automatic needle holder. 



70 a nurse's guide 

Three glover's needles for horse hair for superficial 
sutures. 




Surgeon's full-curved needles. 

Six glovers' needles for silkworm gut for deep 
sutures. 




Surgeon's half-curved needles. 



Dressing, etc.: 

Iodoform and boric acid powder 1 :5 or salicylic 
acid and boric acid 1 :4. 



FOR THE OPERATING ROOM. 

One-half yard iodoform gauze. 

One-half yard sterilized gauze. 

A large pad of sterilized cotton. 

Abdominal bandage. 

Perineal straps and safety pins. 

Collodion in an aseptic glass. 

Camel's hair brush. 

Two broad strips of adhesive plaster. 




Scalpel. 

Two dozen sterilized towels. 
Twelve sterilized gauze laparotomy compresses. 
Supply of sterilized gauze sponges. 
Three sterilized sheets. 
One sterilized laparotomy sheet. 
Bichlorid, alcohol and physiologic solution for the 
hands. 



Probes. 

The Senn bone-plates may be purchased already pre- 
pared, but the sponges that are in the bottle in which 
they are preserved should be moistened at least every 
six months with a solution of alcohol, glycerin and 
water equal parts. When about to use the plates, wash 
in carbolic acid 5 per cent, and rinse in salt solution. 
The lateral or fixation sutures are attached to a cambric 
needle having a spring eye. 



72 A nurse's guide 

Gastrostomy. 

(Formation of a stomach fistula made necessary in carcino- 
matous, and in some cases of cicatricial stricture of the 
esophagus) . 

The fistula is made for the purpose of introducing 
food into the stomach. Preparations same as for gastro- 
enterostomy with addition of a non-fenestrated rubber 
tube the size of a lajge catheter and eight inches long 
and the exclusion of Murphy button and bone-plates. 

Gastrectomy* 

(Excision of stomach.) 

The same preparations as for gastroenterostomy. 
Ileocolostomy* 

(Anastomosis between ileum and colon.) 

Set of Murphy buttons. Prepare second size plates, 
instruments, sutures, etc., as for gastroenterostomy. 

Inguinal Colostomy, 

(Incision of colon to form artificial anus.) 

Two scalpels. 

Two tissue forceps. 

Four hemostatic forceps. 

One needle .holder. 

One Kocher's director. 

One probe. 

One pair blunt hook retractors. 

One pair of deep hook retractors. 

Three pairs scissors. 

Glass cylinder size of a large lead pencil three inches 
long covered with iodoform gauze, which should 
project well beyond the ends of the glass tube. 



FOR THE OPERATING ROOM. 73 

Sutures: 

Three small round curved needles for braided silk 

Xo. 4 to suture the peritoneum to the colon. 
Two surgeon's needles and two glover's needles 
in reserve. 
Tnless the symptoms are urgent the colon is anchored 
in the abdominal incision by the first operation and the 
bowel is not opened until the second or third day after 
adhesions have formed. For the second operation, pre- 
pare a square of oiled silk or gutta-percha tissue 6x6 
inches with circular fenestrum in center, seal edges with 
chloroform to protect the wound ; the cotton under the 
impermeable cover is sealed with collodion. 
One tenotome. 
Two tissue forceps. 
Two hemostatic forceps. 
A pad of cotton. 
Hygroscopic gauze and bandage. 
Sterilized sheets, towels, gauze sponges and gauze 
compresses. 

Herniotomy. 

(Operation for strangulation and radical cure.) 

Umbilical hernia, inguinal hernia, femoral hernia 

and ventral hernia. 

Hernia is a protrusion of a viscus from its normal 

position. Viscus is any organ of the thorax or abdomen. 

(Hernia may also occur in various parts of the body.) 

One scalpel. 

One bistoury, curved probe pointed. 

Two tissue forceps. 

Two hemostatic forceps, long. 




74 A N-DKS^S GUIDE 

Eighteen hemostatic forceps. 
One needle holder. 
One pair retractors, small. 
One pair retractors, large. 
Three pairs scissors. 



Helical needle. 

One pedicle needle. 
One Kocher's director. 
One probe. 
One tenaculum hook. 




Long hemostatic forceps. 

One b'unt hook. 
One hydrocele trocar. 
Ligatures: 

Catgut 'No. 2, twenty inches long, for pedicle needle 
for double ligature, used to ligate the sac and 



^bsb. 



Hydrocele trocar. 

the omentum when it is diseased or can not be 
reduced. (Braided silk is sometimes used.) 
Sutures : 

Three cambric needles for braided silk No. 4 tc 
suture the intestine if resection is made. 



FOB THE OPERATING ROOM. (0 

Three small curved rieedles for catgut Xo. 3 to 
suture fascia of pectineus muscle to Poupart's 
ligament in femoral hernia. 
(A hernial protrusion below Poupart's ligament 

constitutes a femoral hernia, which is more com- 
mon in women.) 
Three small round curved needles for catgut Xo. 2 

to suture peritoneum. 
Six glover's needles for silkworm gut for wound 

sutures. 
Two glover's needles for horse hair for superficial 

sutures. 
Dressing : 

Iodoform and boric acid powder 1 :5. with collodion 

dressing. 
Sterilized sheets. 
Towels. 

Gauze sponges. 
Gauze compresses. 
Safety pins, bandages and cotton. 
Biehlorid, alcohol, plenty of hot and cold sterilized 

water and physiologic solution for the hands. 

Appendectomy. 
(Excision of appendix vevmiformis for appendicitis). 
Two scalpels. 
Two tissue forceps. 
Four hemostatic forceps, long. 
Eighteen hemostatic forceps. 
Three pairs scissors. 
One needle holder. 
One pedicle needle. 



76 a nurse's guide 

One pair small retractors. 

One pair large retractors. 

One Kocher's director. 

One grooved director. 

One sharp spoon. 

Sterile toothpick tipped with cotton to apply 95 

per cent, of carbolic acid to cauterize the mucous 

membrane of the stump of the appendix. 
Iodoform for the stump. 
Ligatures: 

Catgut Xo. 2 or braided silk No. 5. 20 inches long, 

for pedicle needle, used to tie off the adhesions 

and the appendix. 
Catgut ten inches long, for single ligatures. 




Ordinary director with tongue plate. 

Sutures : 

Catgut Xo. 1 for cambric needle or braided silk 
Xo 4, used to bury the stump of the appendix 
by suturing over it the adjacent serous surfaces. 
For this purpose the purse-string suture of silk 
or catgut is now frequently resorted to. 
(In all cases in which pus is found large fen- 
estrated tubular drains must be kepi in readi- 
ness.) 

Six glover's needles for silkworm gut for deep 
sutures. 

Two small round curved needles, for catgut Xo. 1 
or fine silk for peritoneal sutures. 

Three surgeon's needles for catgut Xo. 3 to suture 
the fascia. 



FOB THE OPERATING ROOM. . « 

Two glover's needles for horse hair for superficial 
sutures. 

Six g] over's needles for silkworm gut for deep 
sutures. 

Two small round curved needles in reserve. 

Two rubber drains and narrow strips of iodoform 
gauze for capillary drainage. 
Dressing, etc.: 

Pure iodoform powder and salicylic acid and 
boric 1 :4. 

Iodoform gauze one-half yard. 

Sterilized gauze one yard. 

A large pad of sterilized cotton. 

Two strips of adhesive plaster. 

Abdominal bandage. 

Perineal straps. 

Twelve sterile towels. 

Twelve sterile gauze compresses. 

Twelve sterile safety pins. 

Three sterile sheets. 

One sterile laparotomy sheet. 

Suooly sterile gauze sponges. 

Co^oclion in an aseptic glass and camel's hair 
brush. 

Bichlorid solution 1 :1000, alcohol and physiologic- 
solution for the hands. 

Cholecystcnterostomy. 
(Formation of a communication between the gall-bladder and 
the upper part of the small intestine. ) 

Two scalpels. 

Two tissue forceps. 

Two Billroth's hemostatic forceps. 



NURSES GUIDE 



Two long hemostatic forceps. 
Eighteen hemostatic forceps. 
Six Tait's hemostatic forceps. 
Smallest Murphy button. 
One needle holder. 
One pair small retractors. 
One pair large retractors. 
Exploring syringe.' 
Large and small probes. 
Fenestrated dull curette. 
Small curved forceps. 




Tait's hemostatic fqrceps. 
Ligatures: 

Catgut No. 2, ten inches long. 
Sutures : 

Three round curved needles for braided silk No. 7. 
Three cambric needles for fine silk for fixation 

sutures. 
Six surgeon's needles for silkworm gut for deep 

sutures. 
Sterilized gauze, adhesive plaster, abdominal 
bandages, perineal straps, safety pins, sheets, 
towels, gauze compresses, gauze sponges. 

Chokcystotomy* 

(Opening the gall-bladder.) 

Cholecystotomy in two stages. In these cases the 
gall-bladder is anchored by suturing, with fine round 



\\)\l Tii K 0PEKAT1 \c ROOM. 



; :• 



curved needles and braided silk No. 5. to the parietal 
peritoneum, and the wound tamponed with iodoform 
gauze. On the third day, adhesions having formed, the 
gall-bladder is opened and drained. It is well in every 
ease of gall-bladder operation to prepare the following : 

One tenotomy knife. 

One small dull curette. 

One sharp curette. 

Rubber tubing for drainage 

Cholecystostomy. 
(Formation of a biliary fistula for obstruction of cystic or 
common bile duct caused by biliary calculus, cicatricial stenosis 
or malignant diseases.) 




Potain's aspirator. 

Operation is performed frequently for the removal 
of gallstones. Preparation same as for cholecvstenter- 
ostomy. In all operations upon the gall-bladder an ex- 
ploring syringe and bottle aspirator should be kept in 
readiness and in good working order. 

Cholecystectomy. 

(Excision of gall-bladder. ) 
Requirements as for cholecystenterostomy minus the 
Murphy button and curettes, with the addition of one 



80 



A NULiSE S GUIDE 



pedicle needle and braided silk No. 8 or catgut No. -1 
twenty-four inches long, two pedicle forceps and sterile 
toothpick with one point charged with pure carbolic- 
acid. 



FOR THE OPERATING ROOM. 8! 



CHAPTER IX. 

Gynecological Operations* 

Uterine Curettage. 

(Scraping the interior of the uterus.) 

One small uterine dilator. 

One large uterine dilator. 

One sharp curette. 

One dull curette. 

One uterine sound. 

One uterine probe. 

One dressing forceps. 

One uterine applicator tipped with cotton. 

Two Sims' specula. 

One tenaculum forceps. 

One vulsellum forceps. 

One pair scissors. 

Two tenaculum hooks. 

One intra-uterine douche tube. 

Tincture of iodin, vaselin, glycerin, iodoform 

powder, iodoform gauze strips, sterile lamb's wool 

and cotton — either of the latter may be used 

for tampons. 
Corrosive sublimate solution 1 :4000, boric acid 

solution 2 per cent. — one-half gallon each for 

irrigation, 
gynecological drawers, Kelly apron, eight sterilized 

towels, three sheets, leg holders, sterile gauze 

sponges. 



82 a nurse's guide 

Caution. — The intra-nterine douche tube is a very 
useful though dangerous instrument in the hands of 
an unskilful nurse. 

Preparation and Use. 

First — Boil for fifteen minutes in soda solution. 
Second — Expel the air by allowing the solution to 

run freely before inserting. 
Third — Do not insert beyond the shield. 
Fourth — Hold in position while using. 
Fifth — Use no force. 
Sixth — Attach a rubber tube to the back flow canula 

and provide a basin for the escaping fluid. 

Perineorrhaphy and Trachelorrhaphy. 

(Perineorrhaphy: Suture of the perineum.) 
(Trachelorrhaphy: Suture of the cervix). 

Two scalpels. 

Two tissue forceps. 

Twelve artery forceps, Kocher's. 

One vulsellum forceps. 

One tenaculum forceps. 

One needle holder. 

Two tenaculum hooks. 

Two pairs scissors, straight and curved on the- 

flat. 
One uterine dressing forceps. 
One uterine sound. 
One uterine douche tube. 
Two Sims' specula. 
Ligatures : 

Catgut, fine and medium, ten inches long. If silk 

is called for give No.. 5 and No. 7. 



'OR THE OPERATING IIOOM. 



83 



Tenaculum hook. 



Emmet's plain applicator. 






Sim's uterine probe. 



Dull curette. 
fk 

Curette. 



Munde's curette. 




Goodell's uterine dilatoi 



84 a nurse's guide 

Sutures : 

Two Hagedorn needles (full curve) for braided si lie 

No. 8 for stay sutures. 
Two surgeon's needles (full curve) for medium 

catgut. 
Two curved round needles for medium catgut. 
Three full curved Emmet's needles for catgut. 
Three Emmet's needles, quarter curved, for silk- 
worm gut. 
Bichlorid solution 1 :4000 fer irrigation. 
Boric acid solution 2 per cent, for irrigation. 
Vaselin (hand vaselin on an aseptic sponge). 
Iodoform and boric acid 1 :5. 
Pure iodoform. 
Dressing, etc.: 

Five strips of iodoform gauze three inches in width. 
Two strips of iodoform gauze eight inches in width. 
Sterilized cotton. 
"T" bandage. 
Leg holders. 
Eight sterilized towels. 
Three sterilized sheets. 
Sterilized gauze sponges. 
Gynecological drawers. 
If the leg holders are not convenient, fold a sheet 
in triangular shape, roll it towards the point, place 
under the knees of the patient, drawing them up, bring 
one end over the shoulder and under the opposite arm 
and tie. 

After operation a towel should be pinned around the 
limbs to hold them in position. 



FOB THE OPERATING ROOM. 

These patients are confined to light diet for a few 
days. 

Colporrhaphy. 

(Suture of the vagina.) 

Same preparation as for perineorrhaphy. 

Vaginal Hysterectomy. 

(Excision of uterus. Removal of uterus through the vagina). 

One scalpel. 
One bistoury. 

Two tissue forceps. 
Two vulsellum forceps, six pronged. 
Two vulsellum forceps, two pronged. 
Two vulsellum forceps, four pronged. 
Eight clamp forceps, eight inches. 
Eight Kocher's artery forceps. 
Four long curved artery forceps, Pean's. 
Three long curved artery forceps, Spencer Wells'. 
One uterine dressing forceps. 
One pair vaginal retractors. 
One pair scissors, curved, blunt pointed. 
One pair scissors, curved, sharp pointed. 
One pair scissors, straight. 
Two Sims' specula in reserve. 
Two tenaculum hooks. 
One pedicle needle. 
One Sims' self-retaining catheter. 
One elastic rubber catheter. 
Ligatures : 

Catgut No. 4 and No. 5, twenty-four inches long, 

for two pedicle needles for double ligature. 
Catgut No. 2 and No. 3, ten inches long, for single 

ligatures. If silk is called for give No. 7 or 

No. 8, same length. 



86 a nurse's guide 

Sutures may be required. Prepare round curved 
needles, small, medium and large for catgut. 
Dressing _, etc.: 

Six strips of iodoform gauze eight inches in width. 
Three strips of iodoform gauze three inches in 

width. 
Sterilized cotton. 
Hygroscopic gauze. 
"T> bandage. 
Gynecological drawers. 
Three sheets. 
Eight towels. 
Gauze sponges. 
Kelly pad. 
Leg holder. 
Solutions: 

Boric acid 2 per cent., bichlorid 1 :400 — one-half 
gallon of each for irrigation. 

Oophorectomy or Salpingo-Oophorectomy, 

(Excision of Fallopian tube and ovary for pyosalpinx). 
Pyosalpinx. — Pus in the Fallopian tube, hydrosalpinx 
— water in the Fallopian tube. Ovarian tumor — solid, 
cystic or dermoid. Hysteropexy: abdominal fixation 
of uterus. 

Two scalpels. 

Two tissue forceps. 

Six long hemostatic forceps. 

Twenty-four hemostatic forceps. 

One needle holder. 

Two curved pedicle forceps. 

Two vulsellum forceps, two pronged. 



FOB 'nii: oi'i:.: a ri xii room. 

One "T"-shaped artery forceps. 

One pedicle need 
One Kocher's director. 
One grooved director. 
One exploring syringe. 
One bottle aspirator. 
Rubber drains. 




Semi's bullet forceps. 



Two glass drains (Keith's) lightly packed with a 

strip of iodoform gauze. 
Three pairs scissors. 
One pair deep retractors. 
One pair small retractors. 
One- small probe. 
Ligatures: 

Catgut Xo. 2, ten inches long, for single ligatures. 



88 a nurse's guide 

Uatgut No. 4 and No. 5, twenty-four inches longv 

for pedicle needle for double ligatures. (If 

braided silk is called for give No. 8 the same 

length.) 
Sutures: 

Six glover's neec^es for silkworm gut for deep 

sutures. 
Two round curved needles for catgut No. 1 or fine 

silk for peritoneal sutures. 
Two surgeon's needles for catgut No. 3 for fascia 

sutures. 
Two glover's needles for horsehair for skin 

sutures. 
Two cambric needles and two small round curved 

needles in reserve. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 
Pure iodoform powder. 
One-half yard iodoform gauze. 
One yard sterile gauze. 
Pad of sterile cotton. 
Adhesive plaster strips. 
Abdominal bandage. 
Perineal straps and safety pins. 
Twelve sterilized towels. 
Twelve sterilized gauze compresses. 
Three sterilized sheets. 
One sterilized laparotomy sheet. 
For ovarian tumor prepare one ovarian trocar with 
rubber tubing attached and two cyst holding forceps 
'Semi's bullet forceps). 



FOB THE OPERATING ROOM. 89 

Abdominal Hysterectomy or Hysteromyomectomy. 

(Removal of the body of the uterus for myoma by the abdom- 
inal route, i 

Hysterectomy for carcinoma of the uterus is performs 1 
either through the abdomen or both operations are com- 
bined. Requirements as for the preceding case minus 
the trocar, with the addition of the following: 
Four cambric needles for catgut No. 4. 
Three large round curved needles for catgut No. 4. 
Four long straight hemostatic forceps. 
Four long curved hemostatic forceps.. 
Aseptic rubber cord or tubing for uterine con- 
strictor. 

Myomectomy. 

(The removal of a uterine tumor by enucleation either by the 
vaginal or abdominal route.) 

Preparation the same as for Cesarean section minus 

the obstetrical appliances. 

Cesarean Operation* 

(Removal of usually living child by abdominal incision.) 
The Porro operation accomplishes the same, but in- 
c!udes at the same time the supra-vaginal removal of the 
uterus. 

Two scalpels. 

Two tissue forceps. 

Two hemostatic forceps, long. 

Twenty-four hemostatic forceps. 

Six hemostatic forceps (Tait's). 

One "T"-shaped artery forceps. 

Two pedicle forceps. 

One pedicle needle. 

One needle holder. 



90 a nurse's guide 

One pair retractors, large. 
One pair retractors, small. 
One Kochers director. 




Vaginal retractor. 

One grooved director. 

One elastic constrictor of rubber cord or tubing. 

Three pairs scissors. 

One uterine dressing forceps. 




Bozeman's dressing forceps. 

Ligatures : 

Catgut Xo. 2 and Xo. 3 ten inches long. 
Sutures : 

Three cambric needles for catgut Xo. 4 or fine silk 
to suture the uterus. 




Bullet forceps or double tenaculum. 

Three large curved round needles for catgut Xo. 4. 
Six glover's needles for silkworm gut for deep 
sutures. 



FOB THE OPERATING BOOM. DJ 

Two glover's needles for horsehair for superficial 

sutures. 
Two round curved needles for catgut Xo. 1 or fine 

silk to suture the peritoneum. 
Two surgeon's needles for catgut Xo. 3 to suture 

the fascia. 
Two fine round curved needles and two fine cambric- 
needles in reserve. 
One-half yard of braided silk to tie the umbilical 

cord. 
Fluid extract of ergot, olive oil, toilet powder and 

a warm blanket. 
Dressing : 

Iodoform and boric acid powder 1:5 or salicylic 

and boric acid 1 :4. 
One-half yard iodoform gauze. 
Pad of cotton. 

One-half yard of sterile gauze. 
Adhesive plaster. 
Abdominal bandages. 
Perineal straps. 
Collodion in an aseptic glass and camel's hair 

brush. 
Twelve sterilized towels. 
Twelve sterilized safety pins. 
Twelve sterilized laparotomy sponges. 
Supply of sterilized gauze sponges. 
Three sterilized sheets. 
One sterilized laparotomy sheet. 
Perineal dressing consists of narrow strips of iodoform 
gauze, eight-inch strip of sterile gauze, cotton and 
"T" bandage. Corrosive sublimate solution 1 :1000. 



92 A NURSES GUIDE 

alcohol and plenty of hot saline solution, for hand and 
surface disinfection. 

Obstetric Notes. 
Promptitude in Answering a Call. 

"It is during the first stage of labor that the nurse 
is likely to be summoned, and she should answer the call 
as promptly as possible so as to have time to make all 
necessary preparation for the birth of the child without 
hurry." (Clara Weeks.) 

Nurse's Obstetrical bag should contain : 

Thermometers (clinical and bath). 

Ether cone. 

Hypodermic syringe. 

Medicine dropper. 

Graduated medicine glass. 

Glass and rubber catheter. 

Fountain syringe. 

Scissors and forceps. 

Bottle of bichlorid tablets. 

Small bottle of acetic acid. 

Boric acid, two ounces. 

Carbolic acid. 

Small package of absorbent cotton. 

Braided silk tape or cord. 

Safety pins, two sizes. 

Sterile gown. 
If previous arrangements have been made with the 
expectant mother, the nurse will frequently be asked to 
make out a list of the needed articles so that ample 
provision may be made. The following list contains 
the essential articles, but a more ample one according 
to the means or taste of the individual may be given : 



FOB THE OPERATING ROOM. 93 

For the baby will be needed — 
Blanket. 
Pair of round pointed scissors, not too sharp, to 

cnt the umbilical cord, and tape or braided silk 

with which to tie it (heavy Chinese silk is the 

best). 
Bottle of olive oil. 
Castile soap. 
Absorbent cotton. 
Small soft sponge. 
Box of talcum powder. 
Four dozen cotton diapers in four sizes. 
Four flannel bands, eighteen inches long and about 

six inches wide. 
Four long-sleeved flannel shirts. 
Six flannel skirts. 
Eight plain slips. 
Several soft blankets. 
Two dozen nickel-plated safety pins. 

For the mother : 

Four or six plain night dresses. 

One or two flannel wrappers of light material. 

Pound of absorbent cotton. 

Pound of ordinary cotton batting. 

Six or eight yards of antiseptic gauze. 

Four or six strong unbleached muslin bandages. 

Rubber sheet. 

For the doctor: 

A supply of clean towels. 
A sterile new nail brush. 
Soap and hot and cold water. 



94 A NURSE^S GUIDE 

Ice. 

Three basins. 

Bed-pan. 

Fountain syringe. 

Sterile glass catheter. 

Brandy, ergot, chloroform, ether, carbolic acid and 
bichlorid solution. 
The parturient woman must be regarded in the light 
of a surgical case and everything that is brought in con- 
tact with the genitals must be aseptic. Hand disinfec- 
tion and the use of sterile absorbent dressings are as 
important here as in the treatment of wounds. 



FOB THE OPERATING ROOM. 95 



CHAPTER X. 

Opening of an Abscess. 

(An abscess is a circumscribed cavity containing the fluid 
product of suppurative inflammation.) 

The nurse must here remember the aseptic precautions 
to be observed in order to prevent further infection or 
mixed infection, therefore disinfect the skin sufficiently 
far beyond the line of incision. 

Instruments: 
One scalpel. 



Bistoury. 

One bistoury. 

One tissue forceps. 

One probe. 

One sharp spoon. 

One pair scissors. 

Three hemostatic forceps. 

One glass syringe, 

Peroxid of hydrogen, bichlorid 1 :3000 for irriga- 
tion. 

Fenestrated rubber drains. 

Safety pins. 
If it is a tubercular abscess prepare iodin solution 
sherry color (tincture of iodin one dram to water one 
quart). 



96 a nurse's guide 

Dressing, etc.: 

A heavy compress of hygroscopic gauze moist with 

saturated solution of acetate of aluminum, hot. 

Waxed paper or oiled linen, cotton bandages, safety 

pins. 

Wounds that suppurate profusely are dressed every 

day and sometimes twice a day. 

Heat and moisture in the form of hot antiseptic 
fomentations relieve pain, reduce swelling and inhibit 
suppuration. The antiseptic hot compress has almost 
entirely taken the place of the old-fashioned filthy poul- 
tice. 

Operation for Hare-Lip. 

(Hare-lip: Congenital fissure of lip.) 
If the operation is performed without an anesthetic, 
the child's arms must be fastened to the sides of the 
body with a towel or a broad bandage held in place with 
safety pins. 

One tenotome. 

One scalpel. 

One needle holder. 

One Kocher's director. 

One probe. 

One pair sharp retractors. 

Two tissue forceps. 

Two tenaculum hooks. 

Two blunt hooks. 

Two pairs of scissors. 

Six artery forceps. 
Sutures: 

Three surgeon's needles for catgut No. 1. 

Three glover's needles for silkworm gut. 



FOR THE OPERATING ROOM. 9i 

Three glover's needles for horsehair. 

Narrow strip of iodoform gauze. 

Narrow strip of adhesive plaster. 

Cotton, collodion in an aseptic glass, camel's hair 

brush, safety pins, one-inch roller bandage, six 

towels, gauze sponges. 

Cheiloplasty* 

(Plastic operation on cheek.) 
Same preparation as for hare-lip. 

Rhinoplasty* 

(Plastic operation on the nose.) 

Two scalpels. 

Two tissue forceps. 

Twelve hemostatic forceps. 

One tenotome. 

One Kocher's director. 

One grooved director. 

One probe. 

One pair sharp retractors, three pronged. 

One pair sharp retractors, six pronged. 

One pair scissors, straight, blunt pointed. 

One pair scissors, curved, sharp pointed. 

One pair scissors, small. 

One needle holder. 
Ligatures: 

Catgut, fine and medium, ten inches long, for single 
ligatures. 
Sutures : 

Three surgeon's fine needles, full curved, for fine 
catgut if buried sutures are required. 



98 a nurse's guide 

Three surgeon's medium-sized needles for medium- 
sized braided silk for tension sutures. 
Three surgeon's needles for silkworm gut for flap 

sutures. 
Four glover's needles for silkworm gut. 
Two glover's needles for horsehair for superficial 
sutures. 
If the surgeon takes the flap from the forehead, pre- 
pare silver wire, lead plates, perforated shot, forceps to 
crush the lead plates (sequestrum forceps), razor and two> 
Tait's forceps, with two cambric needles used to spread 
the grafts. The arm or thigh of the patient is prepared 
according to the method given for surface disinfection 
before operation. 

When the flaps are taken from the cheek the skin 
grafting appliances are not necessary. 
Dressing, etc.: 

The usual dressing for the nose consists of a salt 

solution compress. 
Gutta-percha tissue. , 
Absorbent cotton. 
Bandage. 
Safety pins. 
The wound from which the grafts are taken is dressed 
according to the method given for the skin-grafting 
operation. 

Twelve towels. 

Steel gauze sponges. 

Eight-inch compresses. 

Absorbent cotton. 

Narrow strips of iodoform gauze. 



FOR THE OPERATING ROOM. 99 

Amputation of Breast* 

Two scalpels. 

Two tissue forceps. 

One needle holder. 

One aneurysm needle. 

One pair sharp retractors. 

One pair deep retractors. 

One Kocher's director. 

Three pairs scissors. 

Twenty-four hemostatic forceps. 
Ligatures : 

Catgut No. 2 and No. 3 ten inches long. 
Sutures : 

Two surgeon's needles for catgut No. 2 for buried 
sutures. 




Volkmann's retractor. 

Three large curved surgeon's needles for silk No. 3 

for tension sutures. 
Six glover's needles for silkworm gut. 
Three glover's needles for horsehair. 
Two fenestrated drainage tubes the size of the little 

finger and eight inches in length. 
Gutta-percha tissue in 2y 2 P er cent, carbolic acid 

solution. 
Dressing, etc.: 

Boric acid and salicylic acid 1 :4. 

Three strips of iodoform gauze three inches in 

width. 
Three strips of iodoform gauze eight inches in 

width. 






100 a nurse's guide 

Six strips sterilized gauze eight inches in width. 
Collodion in an aseptic glass and camel's hair brush. 
One yard of sterilized gauze, large pad of cotton. 
Two gauze roller bandages four inches wide and 

three yards in length. 
Twelve sterilized towels. 
Twelve sterilized safety pins. 
Six sterilized gauze compresses. 
A supply of gauze sponges. 
Plenty of hot and cold saline solution. 

Tracheotomy, 

(Incision of the trachea.) 
Two scalpels. 
Two tissue forceps. 
Two tenaculum hooks. 




Long trachea tube. 

Two blunt hooks. 

Two pairs of scissors. 

One tracheotomy tube. 

One pair three-pronged retractors. 

One probe. 

One grooved director. 

Six hemostatic forceps. 
Sutures : 

Two surgeon's needles for catgut No. 2. 

Two glover's needles for silkworm gut. 
Dressing, etc.: 

Protective silk or gutta-percha tissue 4x4. 



FOB THE OPERATING ROOM. 

Iodoform and boric acid powder 1 :5. 
Two narrow strips of iodoform gauze. 
One eight-inch strip of hygroscopic gauze. 
Two-inch cotton roller bandage. 



101 




Trousseau's trachea tube. 

Gauze sponges. 

Two pieces of narrow tape, each 11 inches long. 
Attach one strip to each side of the tracheotomy 
tube and tie around the neck to hold the tube in 
position. The outer tube should not be removed 




Cohen's trachea tube. 

by the nurse, but she removes the inner one every 
hour or oftener, if so directed by the physician. 
The- movable or inner tube should be washed in a 
solution of salt water (one dram of salt to a pint 



102 a curse's guide 

of water), and swabbed out with a chicken feather 
or cotton mop which has been sterilized. Before 
replacing the inner tube ; the tube in the trachea 
should be cleansed also. This is done to remove 
the mucus that collects in and around the tube, 
thus rendering free the entrance and escape of air. 
The temperature of the tracheotomy room must not 

be less than 80 degrees F., and the atmosphere should 

be saturated with steam. 

Adenectomy, 

(Excision of diseased lymphatic glands; it here refers to 
tubercular glands of the neck.) 

Two scalpels. 

Two tissue forceps. 

Two blunt hooks. 

Two tenaculum hooks. 

Twelve artery forceps. 

One pair scissors, straight, blunt pointed. 

One pair scissors, curved, blunt pointed. 

One pair scissors, curved sharp pointed. 

One pair of sharp retractors. 

One pair of blunt retractors. 

One artery needle (aneurysm needle). 

One probe. 

One Kocher's director. 

One grooved director. 

One needle holder. 

Ligatures : 

Catgut No. 1 and No. 2 ten inches long. 

Aneurysm needle for catgut No. 2 twenty inchcv 

long, for ligation of large blood vessels. 

Braided silk may be required. 



FOR THE OPERATING ROOM. 103 

Sutures: 

Three large, curved, round needles for catgut No. 4 
. for muscle suture. 

Two surgeon's needles for catgut No. 2. 
Six glover's needles for silkworm gut. 
Two glover's needles for horsehair. 
Two fine, round, full curved needles in reserve. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 

Three strips of iodoform gauze three inches in 

width. 
Three strips of iodoform gauze eight inches in 

width. 
Six strips of Irygroscopic gauze eight inches in 

width. 
Fenestrated rubber tubes for drains. 
Three-inch strip of iodoform gauze for capillary 

drainage. 
One-half yard of sterilized gauze. 
Large pad of sterilized cotton. 
Two aseptic gauze roller bandages. 
Two plaster-of-paris roller bandages. 
Three sterilized sheets. 
Koll of sterile absorbent cotton. 
Six sterilized gauze compresses. 
Ample supply of sterilized sponges. 
Silk protective or gutta-percha tissue. 
Twelve sterilized safety pins. 
Iodoform glycerin emulsion, 10 per cent., collodion 

in an aseptic glass and camel's hair brush. 
Hot and cold salt solution. 



10-1 



a nurse's guide 
Rectal Fistula. 



(Abnormal tube-like passage about the anus giving vent to 
pus or other secretions.) 

Select and prepare the following instruments: 
One scalpel. 
One bistoury. 

One small Sims' speculum. 
One rectal speculum. 
One probe. 

One grooved director. 
One pair sharp retractors. 
One pair blunt retractors. 
One sharp spoon. 
One needle holder. 




Probe-pointed director. 

Two pairs scissors. 

Two tissue forceps. 

Six hemostatic forceps. 

One glass syringe for peroxid of hydrogen. 

Boric acid or Thiersch's solution for irrigation. 

Kelly apron. 

Gynecological drawers. 

Pacquelin cautery. 

Leg holders. • 
Ligatures : 

Catgut No. 2, 
Sutures : 

Two small fistula needles for catgut No. ]. 



FOB THE OPERATING ROOM. 105» 

Three surgeon's needles for catgut No. 2. 
Three surgeon's needles for silkworm gut.. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 
Six iodoform gauze strips. 

Cotton, "T" bandage, safety pins, six towels, three- 
sheets and gauze sponges. 

Operation for Hemorrhoids by the Use of the Clamp 
and Cautery. 

(Hemorrhoids: Swellings caused by varicose hemorrhoidal 
veins. ) 

One small Sims' speculum. 

One pile clamp (Adams'). 

One pair scissors, blunt pointed. 

Four Kocher's artery forceps. 

Pacquelin cautery in good working order. 

Rectal tampon. 
This tampon is made of a piece of rubber tubing the 
size of thumb and twelve inches in length. Into this 
tube is inserted a glass cylinder three to four inches in 
length. An umbrella of iodoform gauze is fastened to 
the tube by tying a silk ligature over it at a point cor- 
responding with the glass cylinder. Strips of iodoform: 
gauze are used in packing the space between the tube 
and umbrella or mantle of gauze, after, the tube lias 
been inserted into the rectum. 

Vaselin, iodoform gauze strips three and eight 
inches in width, cotton, "T" bandage, gyne- 
cological drawers. 

Leg holders. 

Kelly apron. 

Boric acid or Thiersch's solution for irrigation^ 

8 



106 a nurse's guide 

Six sterilized towels. 
Gauze sponges. 
The rectal tampon is removed forty-eight hours after 
operation. During this time the patient is kept on liquid 
diet. In removing the tube traction is made on the 
mantle of iodoform gauze until the packing is brought 
within easy reach when it is removed with forceps, then 
the tube can be extracted without causing any pain. 
-Bowels not to be evacuated for perhaps four days. 

Operation for Phimosis. 

(Circumcision.) 

One scalpel. 

One tissue forceps. 

One needle holder. 

One probe. 

Two pairs scissors. 

Three hemostatic forceps. 
• Sutures: . \ 

Two fine surgeon's needles for catgut No. 1. 

Two cambric needles in reserve. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 

Vaselin. 

Narrow strips of iodoform gauze. 

Aseptic cotton. 

Collodion. 

Strip of adhesive plaster one-half inch in width 
and seven inches long. 

Towels and gauze sponges. 

Varicocele. 

(Dilation of the spermatic veins.) 
Two scalpels. 
Two tissue forceps. 



FOR THE OPERATING BOOM. 107 

Four hemostatic forceps. 
One pair sharp retractors. 
One pair blunt scissors. 
•One needle holder. 
One aneurysm needle. 
Kocher's director. 
One grooved director. 
One blunt hook. 

Ligatures: 

Aneurysm needle for catgut No. 2 fifteen inches 
long to ligate dilated veins. This is called a 
double or mounted ligature. 

If braided silk is called for give No. 5 or No. 7. 
Sutures : 

Two surgeon's needles for catgut No. 2. 

Six glover's needles for silkworm gut. 

Two glover's needles for horsehair. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 

Narrow strips of iodoform gauze. 

Sterilized cotton. 

Sterilized gauze sponges. 

Four sterilized towels. 

Three sterilized sheets. 

Collodion in an aseptic glass and camel's hair brush. 

Bichlorid and saline solution. 

Gauze roller bandage. 

Two strips of adhesive plaster two inches wide and 
twenty-four inches long. 

Gutta-percha tissue. 



108 a nurse's guide 

Skin Grafting* 

This operation consists in transplanting living skin 
to cover cutaneous defects caused by injury, operation 
or disease. Three methods are employed : 

First — Reverdin's, small grafts of the cuticle only. 
Second — Thiersch's, larger grafts including entire 

thickness of true skin. 
Third — Wolfe's large grafts of skin devoid of sub- 
cutaneous fat. 
Fourth — Krause's, large grafts with underlying fat 
tissue. 
Carefully disinfect the skin from which grafts are to 
be taken. 

Prepare an aseptic razor. 

One sharp curette if grafting is to be done on a 

granulating surface. 
Two artery forceps. 
Two cambric needles. 
The wounds to which grafts are applied should be 
dressed with narrow strips of gutta-percha tissue ren- 
dered aseptic by washing with soap and water and im- 
mersing in solution of bichlorid 1 :1000 for twenty- 
four hours. One-half hour before applying dry with 
aseptic gauze and place in a solution of sodium chlorid 
6/10 per cent. 

Sterilized gauze, cotton, roller bandage and safety 
pins. 
Xote . — Great care must be taken in applying the ban- 
dage. If too much pressure is put on the grafts they 
will die. These wounds are sometimes dressed with a 
light compress of sterilized gauze saturated with a warm 
physiologic solution of salt over which gutta-percha tis- 



FOK THE OPERATING ROOM. L09 

sue is applied. Always have a quart of this solution 
in a basin for the surgeon to dip the razor in before 
cutting the grafts. 

In Wolfe's and Krause's methods a sharp scalpel 
and dissecting forceps must be kept in readiness. 
Excision of Varicose Veins. 

(Dilatation of veins.) 

Esmarch's constrictor. 

Two scalpels. 

Two tissue forceps. 

Six hemostatic forceps. 

Two tenaculum hooks. 

Two blunt hooks. 

One needle holder. 

One arter}^ (aneurysm) needle. 

One probe. 

One Kocher's director. 

One pair sharp retractors. 

One pair blunt retractors. 

Two pairs scissors. 
Ligatures : 

Catgut No. 2 twenty inches long, for aneurysm 
needle to ligate the veins. 

Catgut No. 2 ten inches long, for single ligatures. 

Braided silk No. 5 may be required. 
Sutures : 

Two surgeon's needles for catgut No. 2 for buried 
sutures. 

Six glover's needles for silkworm gut. 

Two glover's needles for horsehair. 

Two small round curved needles in reserve. 



110 A nurse's guide 

Dressing, etc.: 

Boric acid and salicylic acid powder 1 :4. 
Two-inch strip of iodoform gauze, laid over the 
wound and sealed with collodion. Place over 
this a thin layer of sterile cotton and seal, over 
the seal a small dressing of sterile gauze loosely 
applied. Cover with a large pad of sterile cot- 
ton. 
Two gauze roller bandages. 
Posterior hollow splint well padded. 
Twelve sterilized towels. 
Twelve sterilized safety pins. 
Two sterilized sheets. 
Sterilized gauze sponges. 

Bichlorid solution 1 :1000, alcohol, hot and cold 
physiologic solution. 
The limb is kept in an elevated position until the 
wound is healed. 

Nephropexy, 

(Nephropexy: Fixation of the kidney. Nephrorrhaphy : 
Suture of the kidney.) 

Two scalpels. 

Two tissue forceps. 

Two Senn's bullet forceps. 

Four artery forceps. 

Three pairs scissors. 

One needle holder. 

One pair small retractors. 

One pair large retractors. 

One Kocher's director. 

Sutures: 

Three round curved needles for catgut No. 5 or 

silk as the surgeon may direct with which to 

suture the kidney. 



FOB THE OPERATING BOOM. 1 1 T 

Two glover's needles for silkworm gut. 

One glover's needle is used to scarify the kidney. 

A hard circular pillow, two feet in length, eighteen 
inches in circumference, covered with white rub- 
ber and sterile towel. 

Small pad four inches long, three inches wide and 
three inches thick, made of a towel or gauze, to 
be placed under the kidney in front when dress- 
ing is applied. 
Dressing, etc.: 

Six three-inch strips of iodoform gauze for tam- 
poning the wound. 

One-half yard of iodoform gauze. 

Three yards of sterile gauze. 

Large pad of sterile cotton. 

Two gauze roller bandages. 

Two strips of adhesive plaster two inches wide and 
long enough to encircle the body. 

Eight sterile towels. 

Eight sterile safety pins. 

Three sterile sheets. 

Nephrectomy. 

(Excision of the kidney.) 

Same preparations as for nephrorrhaphy with the 

addition of two hemostatic forceps (long), straight and 

curved and artery needle for strong silk with which to 

tie the pedicle, exploring syringe and Pacquelin cautery. 

Resection of Rib for Empyema. 

(Pus in the pleural cavity.) 

The following instruments are required: 
Two scalpels. 
Two tissue forceps. 



112 a nurse's guide 

Two artery forceps, long. 

Six artery forceps. 

One bone-cutting forceps. 

One holding forceps (lion- jaw). 

One periosteal elevator. 

One probe. 

One Kocher's director. 

One grooved director. 

Two pairs scissors. 

One exploring syringe. 

Two large rubber tubular drains. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 

Narrow strips of iodoform gauze. 

One eight-inch strip of iodoform gauze. 

One-half yard of iodoform gauze. 

Three yards of sterilized gauze. 

Large cushion of sterilized cotton. 

Two gauze roller bandages. 

One rubber webbing bandage two inches wide and 
four yards long. 

Ligatures may be required. 
Sutures, etc.: 

Two surgeon's needles for silkworm gut. 

Two glover's needles. 

Six towels. 

Three sheets. 

Oauze sponges. 

Staphylorrhaphy, 

(The suture of cleft-palate, congenital palatine fissure, groove 
or cleft.) 

Whitehead's gag. 
One tenotome. 



FOR THE OPERATING ROOM. 



113 



One staphylorrhaphy knife, double edge, sharp 

point. 
One staphylorrhaphy knife, double edge, probe 

point, 
One staphylorrhaphy knife, curved, probe point. 
One staphylorrhaphy needle. 
One staphylorrhaphy hook. 
One needle holder. 
One tenaculum hook. 
-One blunt hook. 
One periosteal elevator, curved. 




Whitehead's gag. 

Two tissue forceps. 
'Two pairs scissors. 
Six hemostatic forceps. 
Six sponge holders. 
Two lead discs for tension suture. 
Silver wire and silk suture. 
'Two staphylorrhaphy needles with handles. 
One Kocher's director. 
One probe. 

A supply of small sponges. 
Narrow strips of iodoform gauze. 
"-Saturated solution of boric acid for disinfection of 
mouth. 



114 a nurse's guide 

Amputation of Leg. 

Esmarclrs constrictor. 

Two scalpels. 

One amputating knife. 

One Catlin knife (this is nsed only for amputations 

below the knee and elbow). 
Two tissue forceps. 
Twelve hemostatic forceps. 
One bone-cutting forceps. 
One periosteal elevator. 
One Butcher's amputation saw. 
One pair retractors. 
One pair retractors, gauze. 
One pair straight scissors. 
One pair curved scissors. 



Amputating knife. 

Ligatures : 

Catgut No. 1 and No. 2 ten inches long. 
Sutures: 

Two surgeon's needles for catgut No. 2 for buried 

sutures. 
Two surgeon's needles for catgut No. 3 to suture 

the muscles. 
Six glover's needles for silkworm gut to suture 

the flaps. 
Two glover's needles for horsehair for superflciar. 

sutures. 
Fenestrated rubber tube for drain. 
Dressing, etc.: 

Boric acid and salicylic acid powder 1 :4. 
Three-inch strips of iodoform gauze. 



FOB THE OPERATING ROOM. 

One-half yard of iodoform gauze. 
Two yards sterilized gauze. 
Large pad sterilized cotton.. 
Two gauze roller bandages. 
Twelve sterilized towels. 
Twelve sterilized safety pins. 
Three sterilized sheets. 



li:» 



Liston's catlin. 



A supply of sterilized gauze compresses. 
A supply of sterilized gauze sponges. 
Well-padded hollow posterior splint. 
The limb must be placed in an elevated position at an 
angle of at least 45 degrees for two days or more. 

In this or any other case when the blood soaks through 
the dressing and bandage, dust over the blood stains with 




Butcher's saw. 

boro-salic} r lic powder and apply a pad of cotton arid 
bandage. This will prevent the germs from getting 
into the wound through the wound secretion in the moist 
part of the dressing, which is a good culture medium 
for microbes. 

Esmarch's constrictor is used when the surgeon wishes 
to do a bloodless operation and for cases of secondary 
hemorrhage. The limb is rendered bloodless by eleva- 



116 a nurse's guide 

tion for a few minutes. Apply the constrictor high up 
on the limb where the blood vessels and nerves are pro- 
tected by a thick cushion of muscles, and over several 
thickness of an aseptic towel. Under no circumstances 
should the constrictor be left on the limb longer than 
three hours, as there is danger of gangrene resulting 
Lcm the blood supply being cut off too long from the 

tissues. 

Perineal Lithotomy. 

I Incision into the bladder through the perineum for stone. ) 
One scalpel. 

One bistoury, probe pointed. 
Two tissue forceps. 

Two artery forceps eight inches long. 
Six artery forceps, Kocher's. 
One Thompson's searcher. 
One Wheelhouse staff. 
Two lithotomy forceps. 
Three lithotomy staffs. 
One stone-crushing forceps or a lithotrite. 
One scoop and guide. 
. One Kocher's director. 
One grooved director. 
One needle holder. 

One pair scissors, curved, blunt pointed. 
One pair scissors, curved, sharp pointed. 
One pair scissors, straight. 
One pair sharp retractors. 
One pair blunt retractors. 
One blunt hook. 
One tenaculum hook. 
One probe. 



FOR THE OPERATING ROOM, 



117 



Thompson's stone searcher. 




Van Buren's curved sound. 




Bigelow's lithotrite 



Q= 



Wheeihouse's staff. 




.LiniiliiiUnur:: 



Little's director and scoop. 




Little's curved stone forceps. 




Gouley's double-lever lithoclast. 



118 A XURSE-'S GUIDE 

Three steel sounds. 

One silver catheter. 

Three soft rubber catheters Nos. 7, 9 and 11. 
(Nelaton). 

One Thompson's bulb. 

One large rubber drain not fenestrated. 

Large safety pins. 
Ligatures : 

Catgut No. 2 and No. 3 ten inches long. If braided 
silk is called for give No. 5 ten inches long. 
Sutures: 

Two surgeon's needles for silkworm gut. 

Two round curved needles for catgut No. %. 

Two small curved needles for braided silk in reserve. 

Boric acid solution 2 per cent, for irrigation. 
Dressing, etc.: 

Iodoform and boric acid powder 1 :5. 

Iodoform gauze strips three inches in width. 

Iodoform gauze strips eight inches in width. 

Sterilized cotton, aseptic gauze and "T" bandage. 

Eight sterilized towels. 

Three sterilized sheets. 

Gauze sponges. 

Gynecological drawers. 

Suprapubic Lithotomy. 

(Incision above pubes into the bladder for stone.) 
Eequirements as for perineal lithotomy minus the 
staffs, with the addition of Sennas sigmoid catheter and 
rubber tubing attached, Thompson's bulb, rectal bag 
and the usual abdominal dressing and two long strips 
of adhesive plaster. 



FOR THE OPERATING ROOM. Ill) 



CHAPTER XL 

Excision of Maxilla — Upper and Lower. 

(Maxilla, the jaw.) 

Two scalpels. 
Two tissue forceps. 
Two artery forceps, long. 
Two bone-cutting forceps, large. 
One bone-holding forceps, (lion- jaw). 
Eighteen artery forceps. 
One periosteal elevator. 
One cross-cutting bone forceps. 
One probe. 
Two sharp spoons. 
Two blunt hooks. 
Two tenaculum hooks. 
Two pairs retractors, sharp and blunt. 
Three pairs scissors. 
One chain saw. 
One mallet. 
One gouge. 
Two chisels. 
One Kocher's director. 
One grooved director. 
Two tooth forceps, incisor and molar. 
One vulsellum forceps. 
Pacquelin cautery. 
Ligatures : 

Catgut No. 1 and No. 2 ten inches long. 



120 



i nurse's guide 



Sutures : 

Two surgeon's needles for catgut medium for muscle - 

sutures. 
Two surgeon's needles for catgut fine to suture the 

mucous membrane. 
One surgeon's large curved needle for silk No. 8 

for the tongue. 




Fergusson's lion-jawed forceps. 

Six glover's needles for silkworm gut for the flap. 
Two glover's needles for horsehair for superficial 
sutures. 
Dressing, etc.: 

Boric acid and salicylic acid powder 1 'A. 




Chain saw: 

Mikulicz's drain, a square of gauze 12x12 inches. 
Rubber tubing and narrow strips of gauze for 

drainage. 
Iodoform gauze one-half yard. 
One yard of sterile gauze. 
One ounce of compound tincture of benzoin. 



FOR THE OPERATING ROOM. L2J 

Large pad of cotton and two gauze roller bandages 

Twelve sterilized towels. 

Twelve sterilized safety pins. 

Three sterilized sheets. 

Sterilized gauze compresses. 

Sterilized gauze sponges. 

Cranial Osteotomy. 

(Opening of skull for cerebral hemorrhage, tumor of the 
brain or fracture of the skull, or epilepsy.) 

Craniectomy* 

(Resection of part of skull.) 

Instruments, etc., as for excision of maxilla, minus 




Langenbeck's drills. 

bone-holding forceps, chain saw, vulsellum forceps and 
Mikulicz's drain, with the addition of the following : 

One tenotomy knife. 

One needle holder. 

One De Vilbiss bone-cutting forceps. 

One large trephine. 

One small trephine. 

One bone drill. 

One foot of silver wire to serve as an electrode for 
the galvanic battery, which is sometimes used 
when the operation is for epilepsy. 

Wilson's cyrtometer. 

Tincture of iodin and a probe tipped with cotton. 



122 



A XUESE S GUIDE 



Physiologic solution at a temperature of 100 degrees 
F. in which to preserve bone temporarily re- 
moved. 
Ligatures : 

Catgut No. 1 eight inches long or braided silk No. 4. 




DeVilbiss" cranial forceps. 

Sutures : 

Two small round curved needles for catgut No. 1 
to suture the dura mater (outer membrane of 
brain and spinal cord). 



D 





Wilson's cyrtometer. 

Two surgeon's needles for catgut No. 1 for peri- 
osteal sutures. 

Two glover's needles for silkworm gut for flap 
sutures. 



FOR TJIK OPERATING ROOM. L23 

Two glover's needles for horsehair for superficial 

sutures. 
A bundle of catgut or horsehair is sometimes used 

for drainage. 
Collodion in an aseptic glass and camel's hair brush. 
Two plaster-of-paris bandages (immerse one roll at 

a time. 
Protective silk or gutta-percha tissue and a copius 
aseptic absorbent dressing. 
Hot physiologic solution of salt is sometimes called 
tor with which to arrest troublesome capillary hemor- 
rhage. 

Sequestrotomy* 

(Operation for the removal of a sequestrum, fragment of 
necrosed bone.) 

Esmarch's constrictor. 
Two scalpels. 
Two tissue forceps. 
Twelve hemostatic forceps. 
One sequestrum forceps. 
One bone-cutting forceps. 
One periosteal elevator. 
One sharp spoon, small. 
One sharp spoon, medium. 
One sharp spoon, large. 
Two gouges (round chisel). 
Two chisels. 
One mallet 

One Kocher's director. 
One grooved director. 
Two probes, long and short. 
One pair sharp retractors. 



124 



A nurse's guide 

One pair blunt retractors. 
One pair scissors, curved, blunt. 




IIHiiiii MlfirlpP 



One pair scissors, straight. 

One glass syringe for peroxid of hydrogen. 

Bichlorid solution 1:3000. 




Mace wen's gouge. 

Decalcified bone chips. Place the chips on sterile 
gauze and dust with iodoform powder before 
handing; to the surgeon. 




Serin's periosteal elevator- 

For tubercular osteomyelitis, prepare a solution of 
iodin, sherry color, tincture of iodin one dram to water 
one quart and iodoform emulsion 10 per cent. 




Macewen's chisel. 

Sutures : 

Two surgeon's needles for catgut No. 2 for muscle 
and periosteal sutures, called buried sutures. 



FOE THE OPERATING ROOM. L25 

Two largo curved needles for silk for tension su- 
tures. 

Six glover's needles for silkworm gut. 

Two glover's needles for horsehair for superficial 
sutures. 




Curved sequestrum forceps. 

Ligatures: 

Catgut No. 1 and No. 2 ten inches long. 
Dressing, etc.: 

Drainage tubes. 




Rawhide mallet. 

Iodoform and boric acid powder 1 :5. 
Protective silk or smtta-percha tissue. 
One-half yard iodoform gauze. 
One yard sterile gauze. 




Von Bruns' chisel. 

Pad of sterile cotton. 
Two gauze roller bandages. 
Two common roller bandages. 
Posterior hollow splint, well padded. 



126 a nurse's guide 

Plaster-of-paris bandages and a roll of common 

cotton in reserve. 
Twelve sterilized towels. 
Three sterilized sheets. 
A supply of gauze sponges. 
A supply of gauze compresses. 
Six safety pins. 

Resection of Joints. 

Eequirements as for preceding case minus the ampu- 
tating knives, with the addition of the following : 
Two chisels. 
Two gouges. 




Windler's saw. 

Two long artery forceps. 

One mallet. 

One Volkmann's sharp spoon. 

One set of bone drills. 

One scroll saw. 

Silver wire. 
For tubercular cases prepare iodin solution for irriga- 
tion, sherry color (about a dram of iodin tincture to 
quart of sterilized water). Iodoform emulsion 10 per 
cent. Plaster-of-paris bandages. 



FOB THE OPEEATING ROOM. 



127 



Decalcified bone chips may be required. 
Thermo-eautery is sometimes used to check bleeding 
from the vessels of the bone. 




Volkmann's bone spoons. 




Senn's injection syringe. 

Drainage : 

A mop of catgut. 
Eubber tubing. 
Iodoform gauze. 

Arthrectomy. 

(Excision of soft structures of joints.) 
Preparation same as for resection of joint? 




Seun's chatelaine for nurs 



INDEX. 



Abdominal incisions, suturing of, 
65 

operations, 66 
Abscess, opening of, 95 
Adenectomy, 102 

After-treatment of laparotomy pa- 
tients, 57 
Air-embolism, danger of, 33 
Anesthesia, general, 13 

method for chloroform, 16 

method for ether, 24 

preparations for, 14 

preparation of patient for, 30 

requisites for, 15 
Anesthesia, local, 24 

by cocain, 26 

by ether spray, 25 

by ethyl chlorid, 26 

by methyl chlorid, 26 

by salt and ice, 25 

by Schleich's method, 28 
Anesthesia, spinal, 30 
Appendectomy, 75 
Arthrectomy, 127 
Auto-transfusion, 62 
Bacteria, thermal death point, 36 
Bag, obstetric, 92 
Breast, amputation of, 99 
Capillary drainage, 34 
Catgut, chromicized, method of 
preparation, 39 

sterilization of, 39 

sterilization, Von Bergmann's 
method, 41 
Catheterization after laparotomy, 

59 
Cautery, Pacquelin or thermo-, 55 
Cesarean operation, 89 
Cheiloplasty, 97 
Cholecystectomy, 79 
Cholecystenterostomy, 77 
Cholecystostomy, 79 
Cholecystotomy, 78 



Cocain as local anesthetic, 27 
Colostomy, inguinal, 72 
Colporrhaphy. 85 
Constrictor, Esmarch's, 115 
Cut ton, borated. 49 
Craniectomy, 121 
Curcuma tincture, formula for, 49 
Data, metric system, 43 
Diet after laparotomy, 58 
Disinfection, sterilization and, 35 

chemical, 36 

of hands, 13, 35 

of skin, 36 

of wounds, 35 
Drainage and drainage material, 
34 

tubes, sterilization of. 35 
Dressings, for laparotomy, 38 

sterilization of, 35, 38 
Dressings, preparation of 

Borated cotton, 49 

Carbolic gauze, 49 

Iodoform gauze, 48 

Sublimate gauze, 49 
Douche, intrauterine, 82 
Empyema, resection of rib for, 111 
Emulsion, iodoform, 47 
Enema, high rectal, 63 

turpentine, 63 
Esmarch's constrictor, 115 
Eistula, rectal, 104 
Fixation splint, Senn's, 51 
Gauze, preparation of, 48, 49 
Gastrectomy, 72 
Gastro-enterostomy, 66 
Gastrostomy, 72 
Hands, disinfection of, 13 
Hare-lip, operation for, 96 
Hemorrhage, auto-transfusion in, 

62 
Hemorrhages, internal and sec- 
ondary, 61 
Hemorrhoids, operation for. 105 



INDEX. 



Herniotomy, 73 

Horsehair, sterilization of, 42 

House, private, operating-room 

in, 9 
Hysterectomy, abdominal, 89 

preparation of patient for, 53 

vaginal, 85 
Hysteromyomectomy, 89 
Ileo-colostomy, 72 
Incisions, abdominal, suturing of, 

65 
Inguinal colostomy, 72 
Injection, intravenous, 30 
Instruments, care of, after opera- 
tion, 55 
Instruments required for 

Opening an abscess, 95 

Adenectomy, 102 

Amputation of breast, 99 

Amputation of leg, 114 

Appendectomy, 75 

Arthrectomy, 127 

Cesarean operation, 89 

Cheiloplasty, 97 

Cholecystectomy, 79 

Cholecystenterostomy, 77 

Cholecystostomy, 79 

Cholecystotomy, 78 

Circumcision, 106 

Colostomy, 72 

Colporrhaphy. 85 

Craniectomy, 121 

Cranial osteotomy, 121 

Curettage, uterine, 81 

Empyema, 111 

Excision of maxilla, 119 

Fistula, 104 

Gastrectomy, 72 

Gastroenterostomy, 66 

Gastrostomy, 72 

Operation for hare-lip, 96 

Operation for hemorrhoids, 105 

Herniotomy, 73 

Hysterectomy, abdominal, 89 

Hysterectomy, vaginal, 85 

Hysteromyomectomy, 89 

Ileocolostomy, 72 

Lithotomy, perineal, 116 

Lithotomy, suprapubic, 118 

Myomectomy, 89 

Nephrectomy, 111 

Nephropexy, 110 

Oophorectomy, 86 



Instruments required for— continued 

Perineorrhaphy, 82 

Porro operation, 89 

Resection of joints, 126 

Rhinoplasty, 97 

Salpingo-Oophorectomy, 86 

Sequestrotomy, 123 

Skin grafting, 108 

Staphylorrhaphy, 112 

Trachelorrhaphy, 82 

Tracheotomy, 100 

Varicocele, 106 

Varicose veins, 109 
Instruments, sterilization of, 35. 
Iodoform emulsion, 47 

gauze, preparation of, 48 
Jacket, Sayre's, 50 
Joints, resection of, 126 
Laparotomy patients, after-treat- 
ment of, 57 

catheterization after, 59 

diet after, 58 

dressing for, 38 

preparation of patient for, 52 
Leg, amputation of, 114 
Lithotomy, perineal, 116 

suprapubic, 118 
Maxilla, excision of, 119 
Metric data, 43 

system of weights and meas- 
ures, 44 
Mikulicz drain, 34 
Myomectomy, 89 
Nephrectomy, 110 
Nephropexy, 110 
Obstetric bag, 92 

notes, 92 
Oophorectomy, 86 
Operating-room, duties of nurse 

in, 53 
Osteotomy, cranial, 121 
Pacquelin or thermo-cautery, 55 
Paper, waxed or paraffin, 50 
Perineorrhaphy, 82 
Peritonitis, symptoms, 63 
Phimosis, operation for, 106 
Physical sterilization, 36 
Porro operation, 89 
Preparation of operating-room in 

private house, 9 
Pyemia, 65 

Respiration, artificial, 20 
Rhinoplasty, 97 



INDEX. 



Rib resection for empyema, 111 

Room, preparation of. for anes- 
thesia.. 30 
preparation of. In a private 
house, 9 

Salpingo-Oophoreetomy, 86 

Salt solution, intra-venous injec- 
tion of. 30 
physiologic. 32 

Sapremia. 65 

Say re's jacket. 50 

Senn's fixation splint. 51 

Septicemia, definition and symp- 
toms, 64 

Sequestrotomy, 123 

Shock, surgical, 61 

Skin, disinfection of. 36 
grafting, 108 

Solutions, antiseptic in common 
use, 45 



Solutions, Schleich's, 28 

Spores, bacteria, 37 

Staphylorrhaphy. 112 

Steel sponge, 54 

Sterilization and disinfection, 35 

Suturing of abdominal incisions, 
65 

Sylvester's method of artificial 
respiration, 20 

Table for operation in a private 
house, 10 

Trachelorrhaphy, 82 

Tracheotomy, 100 

Tubular drains, 34 

Uterine curettage, 81 

Varicocele, 106 

Varicose veins, excision of, 109 

Weights and measures, metric sys- 
tem, 44 

^Yound complications, 61 



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